In an article published in the Journal of Endocrinological, authors discussed that type 2 diabetes (T2D) can decrease life expectancy and patients’ quality of life due to its micro- and macro-vascular complications and higher risk of several types of cancer. The authors specified that an emergent important factor in this population is the hepatic involvement—it has been recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It has now been established that NAFLD – a benign condition, may have a significant deleterious impact for diabetic patients—increasing the risk for cardiovascular complications as well as serious hepatic diseases, in particular, NASH, cirrhosis and hepatocellular carcinoma. 

Lifestyle intervention, bariatric surgery and several drug therapies have accumulated evidence of efficacy in treating NASH. However, their durability and safety in the long-term is yet to be proven and some of these modalities may sometimes be associated with side effects or higher risk of adverse events—limiting or contraindicating their regular administration. 

It was suggested that more efforts should be focused towards the primary prevention of such conditions using a behavioral therapy. A multidisciplinary approach should be emphasized upon in the secondary prevention. Predictive algorithms should be applied in the clinical setting to identify patients at higher cardiovascular and hepatologic risks, and for tertiary prevention—for treating diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH, when not contraindicated.

Source: Journal of Endocrinological Investigation. 2018;41(5):509-21.