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Review
. 2021 Sep 15;12(9):1479-1493.
doi: 10.4239/wjd.v12.i9.1479.

Non-alcoholic fatty liver disease in diabetes: When to refer to the hepatologist?

Reshu Khandelwal  1 , Anuradha S Dassanayake  2 , Hari S Conjeevaram  3 , Shivaram P Singh  4
Affiliations
Review

Non-alcoholic fatty liver disease in diabetes: When to refer to the hepatologist?

Reshu Khandelwal et al. World J Diabetes. .

Abstract

Non-alcoholic fatty liver disease (NAFLD) has become one of the most common chronic liver diseases worldwide. A strong relationship exists between NAFLD and diabetes mellitus. There is growing evidence of a mechanistically complex and strong association between the two diseases. Current data also shows that one disease actually leads to worsening of the other and vice versa. Understanding of the various pathophysiological mechanisms involved, natural history and spectrum of these two diseases is essential not only for early diagnosis and management but also for prevention of severe disease forms. Despite the tremendous progress made in recent times in acquiring knowledge about these highly prevalent diseases, the guidelines and recommendations for screening and management of diabetics with NAFLD remain ambiguous. An interdisciplinary approach is required to not only raise awareness of the prevalence of NAFLD in diabetics but also for better patient management. This can help attenuate the development of significant complications, such as cirrhosis, decompensation and hepatocellular carcinoma in these patients, thereby halting NAFLD in its tracks. This review focuses on the pivotal role of primary care physicians and endocrinologists in identification of NAFLD in diabetics in early stages and the role of proactive screening for prompt referral to hepatologist.

Keywords: Diabetes; Fibrosis; Insulin resistance; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis; Steatosis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
Pathophysiologic association between diabetes and non-alcoholic fatty liver disease. NAFLD: Non-alcoholic fatty liver disease.
Figure 2
Figure 2
Algorithm for referral of diabetics with non-alcoholic fatty liver disease to hepatologist. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CAP: Controlled attenuation parameter; FIB-4: Fibrosis-4 score; FLI: Fatty liver index; HSI: Hepatic steatosis index; LFT: Liver function test; LSM: Liver stiffness measurement; NAFLD: Non-alcoholic fatty liver disease; USG: Ultrasonography.
See this image and copyright information in PMC

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