Non-alcoholic fatty liver disease and type 2 diabetes: An update

Abstract

The global prevalence of non-alcoholic fatty liver disease (NAFLD) is rising, along with the epidemic of diabesity. NAFLD is present in >70% of individuals with type 2 diabetes. Although the mutually detrimental relationship between NAFLD and type 2 diabetes has been well established, a multitude of recent studies have further shown that type 2 diabetes is closely linked to the development of cirrhosis, hepatocellular carcinoma, liver-related morbidity and mortality. In contrast, NAFLD also negatively impacts type 2 diabetes both in terms of its incidence and related adverse clinical outcomes, including cardiovascular and chronic kidney diseases. In response to these global health threats, clinical care pathways for NAFLD and guidelines for metabolic dysfunction-associated fatty liver disease have been developed. Several antidiabetic agents have been evaluated for their potential hepatic benefits with promising results. Furthermore, type 2 diabetes patients are increasingly represented in clinical trials of novel therapeutics for NAFLD. However, despite the wealth of knowledge in NAFLD and type 2 diabetes, lack of awareness of the disease and the potential weight of this problem remains a major challenge, especially among clinicians who are outside the field of hepatology and gastroenterology. This review therefore aimed to provide all diabetes care providers with a summary of the latest evidence that supports NAFLD as an emerging diabetic complication of increasing importance, and to present the current recommendations, focusing on the assessment and therapeutic strategies, on the management of NAFLD among type 2 diabetes patients.

Keywords: Metabolic dysfunction-associated fatty liver disease; Non-alcoholic fatty liver disease; Type 2 diabetes.

Figure 1

Evidence‐based pharmacological approach to glycemic control in patients with type 2 diabetes and non‐alcoholic steatohepatitis (NASH) with significant fibrosis. ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; CV, cardiovascular; GLP1rA, glucagon like‐peptide‐1 receptor agonists; HbA1c, glycated hemoglobin; SGLT2i, sodium–glucose cotransporter 2 inhibitors.

Figure 2

Systematic evaluation for patients with type 2 diabetes and non‐alcoholic fatty liver disease. A1AT, alpha‐1 antitrypsin; ALT, alanine aminotransferase; AMA, anti‐mitochondrial antibody; ANA, anti‐nuclear antibody; ASMA, anti‐smooth muscle antibody; CBC, complete blood count; FIB‐4, fibrosis 4 index; HCC, hepatocellular carcinoma; LS, liver stiffness; VCTE, vibration controlled transient elastography.