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. 2014 Jan;107(1):33-41.
doi: 10.1093/qjmed/hct198. Epub 2013 Oct 15.

Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management

Matthew J Armstrong  1 , Jonathan M Hazlehurst, Richard Parker, Elena Koushiappi, Jake Mann, Sheeba Khan, Angela Philips, Liz Chandler, Jill Johnson, Maria Round, Geoffrey Haydon, Mohammad A Karamat, Philip N Newsome, Jeremy W Tomlinson
Affiliations

Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management

Matthew J Armstrong et al. QJM. 2014 Jan.

Abstract

Objectives: To prospectively use a non-invasive algorithm to identify asymptomatic, advanced non-alcoholic fatty liver disease (NAFLD) in a secondary care diabetes clinic and to determine the short-term effect of a multi-disciplinary team (MDT) approach in a liver clinic.

Research design and methods: NAFLD Fibrosis Score (NFS) was calculated in 64 asymptomatic patients with type 2 diabetes. Advanced fibrosis was identified using transient elastography and confirmed with liver biopsy. In a subsequent retrospective study, 95 patients newly referred to the NAFLD MDT clinic were investigated and the impact of the MDT approach assessed.

Results: 25/64 (39.0%) of patients with diabetes had a low NFS (<-1.455). 39/64 (61.0%) patients had a high or indeterminate NFS and were referred for review in the NAFLD MDT clinic, of which 23/39 attended for assessment. 19/23 (82.6%) were diagnosed with NAFLD, of which 6/19 (31.6%) patients had a positive transient elastography (≥8 kPa). Liver biopsy confirmed advanced fibrosis in 5/6 cases, with moderate fibrosis in 1 case. In the retrospective study, 65/95 (68.4%) new referrals to the NAFLD MDT clinic had a diagnosis of NAFLD. Over a median 98 days (IQR 70-182) follow-up, there was a significant improvement in weight (-0.8 kg; P = 0.024), total cholesterol (-0.2 mmol/L; P = 0.044), ALT (alanine transmaminase, -12.5 IU/L; P < 0.001) and GGT (gammu-glutamyl transferase, -13.0 IU/L; P < 0.0001). 7/28 (25%) of patients with diabetes achieved >5% weight loss.

Conclusions: A significant proportion of asymptomatic patients attending type 2 diabetes clinics have undiagnosed advanced NAFLD fibrosis. An MDT approach to NAFLD results in short-term improvements in metabolic and liver parameters.

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Figures

Figure 1.
Figure 1.
Flow diagram of the step-wise identification of advanced NAFLD fibrosis in a routine secondary diabetes clinic. Data from the prospective study using the NFS (13) and LSE to stratify type 2 diabetes patients at risk of advanced liver fibrosis (Heartlands Hospital Birmingham). Key: F0–F4, Kleiner stages of fibrosis (F3/4 = advanced fibrosis/cirrhosis).
Figure 2.
Figure 2.
Proposed strategy for identifying and managing patients with type 2 diabetes at risk of advanced liver fibrosis in secondary care. This guide is based on author opinion only.
See this image and copyright information in PMC

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