It is well known that diabetes is strongly associated with microvascular (e.g. diabetic nephropathy, neuropathy and retinopathy) and macrovascular (e.g. coronary artery and peripheral arterial disease and stroke) complications.1 People with type 2 diabetes mellitus (T2DM) also commonly present with fat accumulation in the liver (steatosis) but this is often overlooked.2
Recent evidence suggests that nonalcoholic fatty liver disease (NAFLD) may have a significant pathogenic role in T2DM.3 The estimated prevalence of NAFLD in people with T2DM is approximately 60% and this may be due to metabolic risk factors common to these diseases.4
Compared with healthy populations, in people with T2DM, NAFLD may increase the risk of cardiovascular disease and more serious hepatic conditions, such as advanced fibrosis due to nonalcoholic steatohepatitis (NASH) and hepatocellular carcinoma.3,4
Diagnosing and treating hepatic complications, including fibrosis, with the same importance as the macrovascular complications may ultimately prevent the fatal comorbidities of T2DM.1
One study, involving the multidisciplinary management of people with T2DM revealed significant rates of undetected NAFLD, some of which had progressed to NASH.5 Conversely, there was a notable incidence of undetected T2DM in people with a diagnosis of NAFLD.5
Due to increasing levels of obesity, the prevalence of both NAFLD and T2DM will likely increase in the coming years.6,7 It is therefore important for diabetologists to be aware of the relationship between these diseases and to be involved in the multidisciplinary management of NAFLD.
NAFLD risk factors
At risk populations, including people with metabolic syndrome, obesity and type 2 diabetes mellitus (T2DM).
Testing for NAFLD
Information on tests carried out in primary care settings to assess people at risk of NAFLD, before referral to specialists to test for advanced fibrosis due to NASH.
Diabetes and NAFLD
Exploring the prevalence of NAFLD in people with Type 2 diabetes mellitus.
The burden of NAFLD and NASH in diabetes
This content looks at the economic and social burden regarding NAFLD and NASH in the context of T2DM.
NASH and obesity
This content explores the prevalence of obesity and NAFLD, lifestyle factors, assessment and diagnosis and links between obesity and advanced fibrosis due to NASH.
Referral and diagnosis of NASH
This content covers screening and referral algorithms and diagnostic tests for patients with suspected advanced fibrosis due to NASH.
NASH and NAFLD toolkit
Discover collated links to resources and screening tools relevant to NAFLD and NASH.
- Fowler M. Microvascular and macrovascular complications of diabetes. Clinical Diabetes 2008;26:77–82.
- Cusi K. Nonalcoholic fatty liver disease in type 2 diabetes mellitus. Curr Opin Endocrinol Diabetes Obe 2009;16:141–9.
- Radaelli M, et al. NAFLD/NASH in patients with type 2 diabetes and related treatment options. Journal of Endocrinological Investigation 2018;41:509–21.
- Dai W, et al. Prevalence of nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus: A meta-analysis. Medicine (Baltimore) 2017;96:e8179.
- Armstrong M, et al. Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management. QJM. 2014;107:33–41.
- Younossi Z, et al. The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe. 2016;64:1577–86.
- Alharbi N, et al. Trends in the prevalence of type 2 diabetes mellitus and obesity in the Arabian Gulf States: systematic review and meta-analysis. Diabetes Res Clin Pract 2014;106:e30–3.
LID/IHQ/18-12//1048E DATE OF PREPARATION: MARCH 2019