Increased risk of serious liver disease in persons with Type 2 diabetes

It is a well-known fact that longstanding Type 2 diabetes can increase the risk of many health issues including cardiovascular, neurological, eye, and kidney disease. But the recent study indicates that more importance and awareness by healthcare providers must also be given to persons with diabetes and its association with non-alcohol-related fatty liver disease (NAFLD).

NAFLD is caused by a build-up of fat in the liver. This is significant as the early stages of the disease do not give rise to any symptoms. So this "silent killer" is very difficult to diagnose early. For the majority of persons with NAFLD, it is a benign condition, but one in six people will go on to develop the aggressive form of the disease, called non-alcoholic steatohepatitis (NASH), leading to liver injury, scarring and eventually in some to cirrhosis, liver failure and even liver cancer.

In the study, the strongest association observed in NAFLD/NASH patients was in those who also had a diagnosis of Type 2 diabetes. Such patients were more than twice as likely to develop aggressive liver disease. This suggests that diabetes could be a good predictor of liver disease progression. Numerous studies have shown that NAFLD is the precursor for diabetes or in simple terms, NAFLD predisposes people to progress to diabetes. And those who develop diabetes are also at an increased risk of progression to advanced liver disease.

When the researchers looked at the profile of patients with advanced liver disease, NAFLD/NASH patients were almost 5 times more likely to be diagnosed with cirrhosis and more than 3.5 times more likely to be diagnosed with liver cancer. Such a late diagnosis also meant a higher death rate.

The incidence of Type 2 diabetes in India is already high that it has been proposed as being the diabetes capital of the world. In addition, the prevalence of obesity is also very high; up to 18% of urban children and adolescents in the Indian subcontinent are overweight or obese.

The high incidence of Type 2 diabetes and obesity combined led to a new term 'diabesity' being coined. A recent report has indicated that diabesity in the next 20 years could reach a staggering 100 million sufferers.

NAFLD has emerged as an important health problem in India, with an overall prevalence of 9-32% among adults, being higher in overweight and/or diabetic persons. This means that controlling blood sugar levels are paramount not only to prevent systemic complications already listed but also to reduce the risk of liver disease.

It is suggested that healthcare workers increase awareness among patients with type 2 diabetes to also undergo a simple blood test for liver enzymes and fibroscan for measuring the liver stiffness almost 6 months to yearly once after the age of 40 years to constantly monitored for liver disease.

Maintaining a healthy lifestyle by consuming sugar-free and fat-free balanced diets and exercising on a regular basis can prevent both obesity and Type 2 diabetes. Healthcare professionals should make them aware of the link between Type 2 diabetes and liver disease and provide necessary intervention strategies required to stop the progression.

Dr Chandan Kumar

MD, DM(Hepatology)

Senior Consultant & Lead Transplant Physician

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