LSM predicts T2D mortality
A JAMA-linked report finds liver stiffness measurement (LSM) is an effective, noninvasive predictor of all‑cause mortality risk in people with type 2 diabetes — it flags liver fibrosis and identifies higher‑risk patients (medicaldialogues.in). The authors suggest using LSM could enable earlier, tailored interventions in T2D care pathways rather than relying on glycemia alone (medicaldialogues.in).
The paper, led by Fernando Bril and colleagues, was published online March 18, 2026 in JAMA Network Open and analyzed vibration‑controlled transient elastography (VCTE) and CAP data from NHANES 2017–2018 linked to the National Death Index through December 31, 2019. (jamanetwork.com) The study cohort numbered 4,102 adults (mean age 47 years; mean BMI 29.5), of whom 808 (14.5%) had diabetes and 24 of those diabetes patients died over a mean follow‑up of 23 months.. (pharmacytimes.com) Each 1‑kPa increment in liver stiffness conferred an adjusted 6% higher hazard of all‑cause death (adjusted hazard ratio [aHR] 1.06 per kPa; 95% CI, 1.04–1.09; P <.001).. (jamanetwork.com) Advanced fibrosis, defined as LSM ≥9.7 kPa, was associated with markedly higher mortality in people with diabetes—an adjusted 6.41‑fold increase in risk compared with absence of both diabetes and advanced fibrosis (aHR 6.41; 95% CI, 1.03–39.85; P =.047).. (pharmacytimes.com) The commonly used FIB‑4 index (threshold 1.30) did not independently predict mortality in multivariable models and showed clinically meaningful discordance with LSM—many participants with FIB‑4 <1.30 still had elevated LSM (≥8 kPa) and higher death risk.. (pharmacytimes.com) Authors and invited commentators noted the study’s short follow‑up and limited VCTE availability as constraints, while also pointing out that current ADA guidance starts screening with FIB‑4 and reserves LSM for elevated FIB‑4—findings from Bril et al. argue that this pathway may miss high‑risk patients.. (jamanetwork.com)
