The link between type 2 diabetes and liver disease: can screening for NAFLD reduce liver-related mortality?

July 23, 2020
Type 2 Diabetes
New Publication
Chloe Hutton
Jasmin Hounsell

Oxford, July 23, 2020. A review of screening modalities and treatment options for individuals with type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) published in Diabetic Medicine puts a spotlight on the link between these two diseases.

NAFLD is a spectrum of conditions ranging from excess liver fat, to inflammation, fibrosis, cirrhosis and end-stage liver disease, with an increased risk of hepatocellular carcinoma. Up to 70% of individuals with type 2 diabetes are thought to have NAFLD and these individuals experience an accelerated course in terms of liver disease progression, with 15% progressing to advanced fibrosis. Studies suggest that individuals with type 2 diabetes have a two- to threefold higher risk of dying from chronic liver disease than the general population, with the majority of deaths being attributable to NAFLD. NAFLD prevalence continues to rise in line with both type 2 diabetes and obesity. It is predicted to become the leading indication for liver transplantation within the next decade and increasingly will be clinically encountered as an important comorbidity.

For individuals with type 2 diabetes, treatments typically include weight loss, physical exercise, glucose-lowering therapies and metabolic surgery which can also lead to improvements in fatty liver disease and to a lesser extent fibrosis. However, not all glucose-lowering therapies are appropriate for individuals with liver disease, emphasising the importance of recognising the relationship between these two diseases.

Systematic screening has not yet been widely adopted in routine diabetes care to assess for presence or severity of NAFLD. The degree of liver fibrosis is the main prognostic factor and liver biopsy remains the gold standard for diagnosis. Various non-invasive screening tools (based on blood tests) are available but tend to be better for excluding fibrosis than detecting it. MRI-based approaches such as those used by Perspectum's LiverMultiScan®, include proton density fat fraction (PDFF) to quantify liver fat and hepatic iron-corrected T1 (cT1) to assess inflammation and fibrosis. This non-invasive imaging technique has been validated against liver biopsy and is predictive of liver-related outcomes. Furthermore, with low failure rates, high repeatability and reproducibility, LiverMultiScan is now increasingly adopted in NASH (non-alcoholic steatohepatitis, advanced form of NAFLD) clinical trials.

With evidence to date suggesting a high burden of unrecognized NAFLD, fibrosis and cirrhosis in type 2 diabetes, increased awareness of the intrinsic link between these two diseases is critical. A multidisciplinary approach with a consensus on screening for NAFLD, followed by risk stratification to identify individuals with liver fibrosis, should be adopted into routine diabetes care.

Dr Helena Thomaides-Brears, Perspectum’s Head of Clinical Sciences commented, “It is important to diagnose liver disease earlier when it is co-prevalent with metabolic disease, especially as semaglutide and other diabetes drugs are showing beneficial effects on NASH”.

Read the paper here.