Type 2 diabetes is considered as an important risk factor for chronic liver disease such as non-alcoholic fatty liver disease (NAFLD). However, current guidelines offers contradictory recommendations on the screening of diabetic patients for NAFLD. The current study determined the approach of screening diabetic patients by FibroScan.

In the current study, FibroScan was used to examine liver stiffness measurements (LSM) while liver fat and fibrosis were analysed by controlled attenuation parameter (CAP) at a diabetic centre for patients from primary care and hospital clinics. Advanced fibrosis was detected with the help of probe-specific LSM cut-offs.

The study recruited 1918 patients, among which 1799 (93.8%) had valid CAP and 1884 (98.2%) had reliable LSM (1770 with the M probe and 114 with the XL probe). The proportion of patients with increased CAP was 72.8% (95% CI 70.7% to 74.8%) and LSM was and 17.7% (95% CI 16.0% to 19.5%). Increased CAP was associated with female gender, higher body mass index, triglycerides, fasting plasma glucose and alanine aminotransferase (ALT) and non-insulin use when measured by a multivariable analysis. Additionally, increased LSM was correlated with longer duration of diabetes, higher body mass index, increased ALT and spot urine albumin: creatinine ratio and lower high-density lipoprotein-cholesterol. Furthermore, 94 patients (80% had increased LSM) underwent liver biopsy, 56% had steatohepatitis and 50% had F3-4 disease.

Thus, these observations concluded that NAFLD and advanced fibrosis is highly prevalent in diabetic patients. Obesity and dyslipidaemia increases the risk of complications in these patients and may be the target for liver assessment. Therefore, screening for NAFLD and/or advanced fibrosis in patients with type 2 diabetes is warranted.

Source: Gut. 2016 Aug;65(8):1359-68.