What is it about?
The prevalence of fatty liver (NAFLD) and fibrosis in patients with T2DM attending regular follow-up visits in the United States is unknown. This study aimed to assess how common both conditions were by doing a Fibroscan (CAP for liver fat and VCTE/elastography for fibrosis) in all patients with t2DM unaware of having NAFLD. We found that the prevalence of hepatic steatosis was 70% and that of liver fibrosis was 21%. almost 1 in 10 patients (9%) had either precirrhosis (F3) or cirrhosis (F4) and 15% moderate-to-advanced fibrosis (F2 or higher). Elevated AST or ALT ≥40 units/L was uncommon in patients with steatosis (8% and 13%, respectively) or with liver fibrosis (18% and 28%, respectively). This suggests that a screening strategy based on plasma aminotransferases alone is insufficient as initial screening and should be combined with additional tests, like imaging.
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Why is it important?
Moderate-to-advanced fibrosis (F2 or higher) affects at least one out of six (15%) patients with T2DM. These results support the American Diabetes Association guidelines to screen for clinically significant fibrosis in patients with T2DM with steatosis or elevated ALT, but also call for a screening strategy beyond aminotransferases alone that includes diagnostic panels (like FIB-4 or APRI) and/or imaging for liver fibrosis.
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This page is a summary of: Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening, Diabetes Care, December 2020, American Diabetes Association, DOI: 10.2337/dc20-1997.
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