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Objective: Type 2 diabetes (T2D) increases the risk for major adverse liver outcomes (MALOs), including cirrhosis and its complications. Patients with T2D frequently have other traits of the metabolic syndrome (MetS). It remains uncertain whether there is a synergistic effect of accumulating MetS traits on future MALO risk., Research Design and Methods: Patients with T2D without a history of liver disease were identified from national registers in Sweden from 1998 to 2021. MetS traits included hypertension, low HDL level, hypertriglyceridemia, obesity, and albuminuria, in addition to T2D. MALO events were identified based on administrative coding from national registers until 31 October 2022. Data were analyzed using Cox regression models., Results: In total, 230,992 patients were identified (median age 64 years; 58% male), of whom 3,215 (1.39%) developed MALOs over a median follow-up of 9.9 years. Compared with patients with one MetS trait (only T2D) at baseline, those with more than one MetS trait had a higher rate of MALOs (adjusted hazard ratio [aHR] 2.33, 95% CI 1.53-3.54). The rate of MALOs increased progressively with increasing numbers of MetS traits at baseline (aHR 1.28 per added trait, 95% CI 1.23-1.33). During follow-up, patients who acquired additional MetS traits had a progressively higher rate of MALOs. The MetS trait with the largest association with incident MALOs was hypertension (aHR 2.06, 95% CI 1.57-2.71)., Conclusions: Having or acquiring additional traits of MetS increase the rate of progression to MALOs in patients with T2D. These results could be used to inform screening initiatives for liver disease., (© 2024 by the American Diabetes Association.)

Competing Interests: Conflict of interest: K. Geale reports research project funding from Novartis for the current work; personal fees for consultancy from Quantify Research, during the conduct of the study and outside the submitted work. Conflict of interest: H. Darabi reports research project funding from Novartis for the current work; personal fees for consultancy from Quantify Research, during the conduct of the study and outside the submitted work. Conflict of interest: M. Lindh reports research project funding from Novartis for the current work; personal fees for consultancy from Quantify Research, during the conduct of the study and outside the submitted work. Conflict of interest: H. Fues Wahl reports research project funding from Novartis for the current work; personal fees for consultancy from Quantify Research, during the conduct of the study and outside the submitted work. Conflict of interest: O. Ström reports research project funding from Novartis for the current work; personal fees for consultancy from Quantify Research, during the conduct of the study and outside the submitted work. Conflict of interest: H. Cao is an employee of Novartis Pharmaceutical Company. Conflict of interest: L.A. Alvares is an employee of Novartis. Conflict of interest: R. Dodge has nothing to disclose. Conflict of interest: E. Loefroth is an employee of Novartis. Conflict of interest: A. Altraja reports personal fees and travel and educational support from AstraZeneca, Berlin-Chemie Menarini, Boehringer Ingelheim, CSL Behring, Roche, Teva and Sanofi, grants, personal fees and travel and educational support from Chiesi (Norameda) and GlaxoSmithKline, personal fees and travel support from MSD, grants and personal fees from Bayer, travel and educational support from Actelion (Johnson and Johnson), personal fees from Shire Pharmaceuticals, outside the submitted work. Conflict of interest: V. Backer has nothing to disclose. Conflict of interest: H. Backman reports personal fees for lectures from AstraZeneca, outside the submitted work. Conflict of interest: L. Bjermer reports personal fees from AstraZeneca, Boehringer, Chiesi, GSK, Novartis, Teva and ALK, outside the submitted work. Conflict of interest: A. Bossios reports personal fees for advisory board work and/or lectures from AZ, Teva, GSK and Novartis, outside the submitted work. Conflict of interest: B. Bøgvald Aarli reports personal fees for lectures from Boehringer Ingelheim, Novartis, AstraZeneca, Chiesi and Alere, personal fees for consultancy from GlaxoSmithKline, and has stock in from KBB Medic AS, outside the submitted work. Conflict of interest: B. Dahlén reports personal fees for lectures and advisory board work from AstraZeneca, GSK, Teva, Sanofi and Novartis, outside the submitted work. Conflict of interest: O. Hilberg has nothing to disclose. Conflict of interest: C. Jansson has nothing to disclose. Conflict of interest: H. Kankaanranta reports grants, personal fees for lectures and consultancy, and non-financial support to attend meetings from AstraZeneca, personal fees for lectures and consultancy from Chiesi Pharma AB, Novartis and GlaxoSmithKline, personal fees for lectures and consultancy, and non-financial support to attend meetings from Boehringer Ingelheim and Orion Pharma, personal fees for lectures from Mundipharma, personal fees for consultancy from Sanofi Genzyme, outside the submitted work. Conflict of interest: J. Karjalainen reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Novartis, Orion Pharma and Teva, outside the submitted work. Conflict of interest: P. Kauppi reports personal fees for lectures from GSK, Teva and Novartis, personal fees for manuscript preparation from Fimea, personal fees for consultancy from Sanofi, outside the submitted work. Conflict of interest: M. Kilpeläinen has nothing to disclose. Conflict of interest: S. Lehmann reports data analysis and manuscript preparation support from Novartis, during the conduct of the study; personal fees for lectures from AstraZeneca, personal fees for manuscript preparation from Boehringer Ingelheim, outside the submitted work. Conflict of interest: L. Lehtimäki reports personal fees from AstraZeneca, Chiesi, GSK, Boehringer Ingelheim, MSD, Novartis, pi tlsb -.005wOrionPharma, ALK, Teva and Sanofi, outside the submitted work. Conflict of interest: B. Lundbäck reports grants from AstraZeneca, personal fees for lectures and advisory board work from AstraZeneca, Novartis, GSK and Sanofi, outside the submitted work. Conflict of interest: T. Sandström has nothing to disclose. Conflict of interest: C. Suppli. Ulrik has nothing to disclose. Conflict of interest: A. Sverrild has nothing to disclose. Conflict of interest: A. Viinanen has nothing to disclose. Conflict of interest: A. von Bülow has nothing to disclose. Conflict of interest: V. Yasinska has nothing to disclose. Conflict of interest: C. Porsbjerg reports grants and personal fees from AstraZeneca, GSK, Novartis, Sanofi and Teva, outside the submitted work.

Background and Purpose: Few economic or quality-of-life studies have investigated the long-term consequences of fragility fractures. This prospective observational data collection study assessed the cost and quality of life related to hip, vertebral, and wrist fracture 13-18 months after the fracture, based on 684 patients surviving 18 months after fracture., Patients and Methods: Data regarding resource use and quality of life related to fractures was collected using questionnaires at 7 research centers in Sweden. Information was collected using patient records, register sources, and by asking the patient. Quality of life was estimated using the EQ-5D questionnaire. Direct and indirect costs were estimated from a societal standpoint., Results: The mean fracture-related cost 13-18 months after a hip, vertebral, or wrist fracture were estimated to be euro2,422, euro3,628, and euro316, respectively. Between 12 and 18 months after hip, vertebral, and wrist fracture, utility increased by 0.03, 0.05, and 0.02, respectively. Compared to prefracture levels, the mean loss in quality of life between 13 and 18 months after fracture was estimated to be 0.05, 0.11, and 0.005 for hip, vertebral, and wrist fracture., Interpretation: The sample of vertebral fracture patients was fairly small and included a high proportion of fractures leading to hospitalization, but the results indicate higher long-term costs and greater loss in quality of life related to vertebral fracture than previously believed.