Mechanisms, screening modalities and treatment options for individuals with non‐alcoholic fatty liver disease and type 2 diabetes

Hydes, TJ ORCID: 0000-0002-7768-6886, Summers, N, Brown, E, Alam, U ORCID: 0000-0002-3190-1122, Thomaides-Brears, H, Wilding, JPH ORCID: 0000-0003-2839-8404 and Cuthbertson, DJ ORCID: 0000-0002-6128-0822
(2020) Mechanisms, screening modalities and treatment options for individuals with non‐alcoholic fatty liver disease and type 2 diabetes. Diabetic Medicine, 37 (11). pp. 1793-1806.

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Non‐alcoholic fatty liver disease (NAFLD) exists as a spectrum of disease ranging from excessive accumulation of fat within the liver (simple steatosis), inflammation (non‐alcoholic steatohepatitis) through to fibrosis, cirrhosis and end‐stage liver disease. There is also an increased risk of hepatocellular carcinoma. The principal risk factor for NAFLD is overweight or obesity, along with type 2 diabetes, and NAFLD itself is also a risk factor for incident type 2 diabetes. Overweight/obesity is synergistic with alcohol consumption in causing progressive and insidious liver damage. Recent consensus advocates a change in nomenclature from NAFLD to ‘metabolic associated fatty liver disease’ (MAFLD), reflective of the associated metabolic abnormalities (insulin resistance/type 2 diabetes and metabolic syndrome components). Additional extra‐hepatic manifestations of NAFLD include cardiovascular disease, chronic kidney disease and certain cancers. Unlike other micro‐ and macrovascular complications of type 2 diabetes, systematic screening or surveillance protocols have not been widely adopted in routine diabetes care to assess for presence/severity of NAFLD. Various screening tools are available (non‐invasive tests and biochemical indices) combined with imaging techniques (e.g. transient elastography) to detect steatosis and more importantly advanced fibrosis/cirrhosis to facilitate appropriate surveillance. Liver biopsy may be sometimes necessary. Treatment options for type 2 diabetes, including lifestyle interventions (dietary change and physical activity), glucose‐lowering therapies and metabolic surgery, can modulate hepatic steatosis and to a lesser extent fibrosis. Awareness of the impact of liver disease on the choice of glucose‐lowering medications in individuals with type 2 diabetes is also critical.

Item Type: Article
Uncontrolled Keywords: Liver, Humans, Diabetes Mellitus, Type 2, Obesity, Thiazolidinediones, gamma-Glutamyltransferase, Alanine Transaminase, Aspartate Aminotransferases, Hypoglycemic Agents, Magnetic Resonance Imaging, Biopsy, Mass Screening, Platelet Count, Exercise, Diet Therapy, Severity of Illness Index, Risk Factors, Bariatric Surgery, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease, Glucagon-Like Peptide-1 Receptor, Metabolic Syndrome, Sodium-Glucose Transporter 2 Inhibitors
Depositing User: Symplectic Admin
Date Deposited: 15 Oct 2020 08:35
Last Modified: 18 Jan 2023 23:28
DOI: 10.1111/dme.14356
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