Liver Disease and Diabetes – Should We be Screening?

Over 50% of people living with diabetes have fatty liver disease.

Over the next 20 years, non-alcoholic steatohepatitis (NASH) and type 2 diabetes will account for 65,000 transplants, 1.37 million cardiovascular-related deaths, and 812,000 liver-related deaths.
These statistics are from a 2020 article in Diabetes Care, Economic and Clinical Burden of Non-alcoholic Steatohepatitis in Patients With Type 2 Diabetes in the U.S.

Relationship between Type 2 and Fatty Liver Disease

Fatty liver disease is increasingly recognized as the hepatic manifestation of metabolic syndrome. Currently, there is no effective approved medical therapy to fix the fatty liver disease, management depends on lifestyle changes, such as weight loss and increased exercise.

Type 2 and Liver Disease Stats

About 34 million people in the U.S. have type 2 diabetes. Of those, over half are also living with liver disease.

In the U.S. in 2019:

  • About 50% (18.2 million people) are living with Type 2 diabetes plus Non-alcoholic fatty liver disease (NAFLD).
  • Of those, 37% (6.4 million) have a more severe form of liver disease known as non-alcoholic steatohepatitis (NASH).
  • Advanced fibrosis among biopsied people with NAFLD and T2DM was 17.02%
  • Twenty-year costs for NAFLD in these patients were $55.8 billion.

Should We Screen People with Diabetes for Liver Disease?

Given the high rate of liver disease in people with diabetes, I have been paying more attention to our client’s liver enzymes levels, including alanine aminotransferase (ALT) or aspartate aminotransferase (AST). Elevated levels of these liver enzymes indicate inflammation and a potential pathway to liver disease progression.

After discovering elevated enzymes, we send them for further diagnostic testing to evaluate the extent of liver disease. The question is, should we make liver health screening a part of our usual diabetes practice?

Is screening cost-effective and what are the next steps?

According to a recent article in Gastroenterology, screening for non-alcoholic fatty liver disease (NAFLD) followed by lifestyle modification among people with type 2 diabetes can be cost effective.

In a recent study, a team of researchers used a hypothetical cohort of people age 55 years with type 2 diabetes and developed a model that compared screening and treatment with no such protocol.

For the virtual intervention group, they measured ALT or AST and provided an ultrasound scan. If these tests came back positive for NAFLD, the participants underwent further screening with liver biopsies and transient elastography.

People found to have NASH with Stage 2 entered a year-long behavior program to help them with weight loss and lifestyle changes. They found the for participants with stage 2 fibrosis or higher, the screening and lifestyle intervention was just as cost-effective compared to the group with no screening.

“Our results indicate the potential value and cost-effectiveness of NAFLD screening” in people with type 2 diabetes, wrote the study authors. “Given the increasing burden of NAFLD/NASH and the expected rapid increase in approved medications, we recommend screening patients with type 2 diabetes for NAFLD.”

Click this link to read more about Screening People with Type 2 for Liver Disease.


Upcoming Cancer & Diabetes Webinar | Level 4 – Advanced Level | 1.5 CEs
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People with cancer often experience hyperglycemia secondary to treatment, which can increase risk of infection and compromise their nutritional status. In addition, recent research has identified the link between diabetes and cancer. Join us to learn more about this unexpected link and treatment strategies for steroid-induced hyperglycemia using a case study approach. 

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