Multidisciplinary statement calls for "any diabetic to be screened for liver disease"

"In any diabetic, especially in older obese patients with metabolic syndrome-related diseases, we need to screen for liver disease," said Dr. Christos S. Mantzoros, a professor at Harvard Medical School and a member of the group that wrote the statement.
two epidemiological reports published in December 2020 highlighted the high incidence and severity of liver disease in people with type 2 diabetes.
One of the reports from the U.S. Centers for Disease Control and Prevention's 2017-2018 National Health and Nutrition Examination Survey, a sample that generally represents the U.S. population as a whole, 825 cases of type 2 diabetes, found a prevalence of liver fat change as high as 73.8 percent, including severe fibrosis of 15.4 percent, cirrhosis of 7.7 percent, and obesity as the main risk factor.
study was conducted in 561 people with type 2 diabetes at the University of Florida Center.
These patients had no previous history of NAFLD or other liver disease or alcoholism, and screening found a 70 percent prevalence of NAFLD between 2018 and 2020, of which 54 percent were diagnosed with severe liver fat change, significant liver fibrosis (F2) was 6 percent, and progress fibrosis or cirrhosis (F3-4) was 9 percent.
Dr. Kenneth Cusi, president of the endocrinology, diabetes and metabolism department at the University of Florida, noted that 15 percent of people with type 2 diabetes who did not realize they had NAFLD were already moderate or even advanced with liver fibrosis, "which should be of concern to all diabetics and clinicians."
Guidelines for the Prevention and Control of Non-Alcoholic Fatty Liver Disease (2018) also point out that the prevalence of NAFLD among people with type 2 diabetes in China is as high as 28% to 70%.
identification of NASH is critical to NAFLD and includes a range of related disease processes: from non-alcoholic simple liver fat change to non-alcoholic fatty hepatitis (NASH), which gradually causes liver fibrosis and may eventually develop into cirrhosis, liver failure and even liver cancer.
, NASH is the intermediate stage of the progression of simple fatty liver disease to cirrhosis of the liver and needs to be treated to improve the level of fatty hepatitis and fibrosis, but NASH usually has no obvious symptoms at an early stage.
, it is important to identify this part of the patient.
the prevalence of NASH was not recorded in neither epidemiological report because it was difficult to clearly diagnose NASH by non-invasional methods such as existing imaging techniques and laboratory tests.
The American Diabetes Association (ADA) and the European Association for Diabetes Research (EASD) have recommended routine screening for liver function in people with type 2 diabetes, including transaminase indicators such as glutamate transaminase (ALT), but no specific screening recommendations have been provided.
Dr. Mantzoros, Dr. Cusi, and several experts agreed that, based on regular monitoring of transaminase elevations, liver fibrosis can be subsequently assessed using ultrasound-based transient elastic imaging techniques, and that the FIB-4 scoring model can also serve as an initial screening tool, combining patient age, plate plate count, and transaminase levels.
Mantzoros noted,
A lot of consensus has been reached in the industry on the above-mentioned methods of hepatosfibrosis assessment, there are no well-established diagnostic tests, and it is imperative to define the best diagnostic tests."
," Dr. Cusi agrees, "more reliable testing is needed to diagnose NASH and advanced fibrosis in people with type 2 diabetes."
is doing a lot of work in this area to validate new and more complex biomarkers, and these studies will help us identify and target patients at higher risk of cirrhosis.
goal is to diagnose fibrosis as early as possible to prevent patients from developing cirrhosis.
" Existing treatment options For patients with type 2 diabetes combined with NAFLD/NASH/hepatic fibrosis, common treatment options currently include weight loss, diet adjustment, and the drug pyridoxine.
However, weight loss and dietary adjustments face compliance and persistence challenges for patients, and many doctors also believe that long-term use of pyridoxine has potential adverse effects, the side effects of which are mainly weight gain and edema.
Yehuda Handelsman, medical director of the American Institute of Metabolism, believes this may also affect the motivation of doctors and people with type 2 diabetes to manage liver health.
if we lack a cure for a disease, we may not be able to monitor or track it, " he said.
is exactly what liver disease is all about.
," however, several experts said that oxycodone remained one of the most supportive treatments available.
the 2020 WCIRDC Academic Conference, Dr. Cusi noted that pyridoxine therapy can reverse NASH in about one-third of patients, ease fibrosis processes and reduce the incidence of cardiovascular disease compared to placebos.
A. DeFronzo, director of diabetes at the University of Texas Health Science Center, also said that "pyridoxine is the best drug for NASH, and the data on pyridoxine (the treatment of type 2 diabetes combined with NASH) are more convincing than any other treatment."
" Dr Mantzoros stressed: "The oxycodone is only used in 8% or fewer people with type 2 diabetes.
the drug has been shown to work for people with type 2 diabetes and NASH and we need to use it more for treatment.
DeFronzo also points out that side effects can be minimized by carefully adjusting the dose.
"Our clinical dosing is 15 mg or 30 mg per day, which can alleviate edema problems. Other strategies for
" include combining pyridoxine with other interventions that may inhibit weight gain, a potential combination therapy that combines pyridoxine with GLP-1-1-subjectors, such as somatroptide, which has shown encouraging activity in Phase 2 clinical trials in patients treating NASH.
While existing testing and treatment options are still inadequate, it is to be expected that the forthcoming multi-society statement will provide advice for the assessment and management of liver disease, which is highly prevalent in patients with type 2 diabetes (T2D).
S. Christos S. Mantzoros said, "It is becoming increasingly clear that non-alcoholic fatty liver disease (NAFLD) and (non-alcoholic fatty hepatitis NASH) treatment requires multidisciplinary physician collaboration, including general practitioners, endocrinologists and liver doctors."
multidisciplinary statement will be the starting point for this important work.
" Resources . . . Widespread Liver Disease Missed in Patients With Type 2 Diabetes. Retrieved January 27, 2020, from [2] Stefano Ciardullo, Tommaso Monti, Gianluca Perseghin. (2020). High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes. Diabetes Care, DOI: [3] Romina Lomonaco, et al., (2020). Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening. Diabetes Care, DOI: China's Guidelines for the Prevention and Control of Non-Alcoholic Fatty Liver Disease (2018)