Liver disease is an important cause of death in type 2 diabetes. Diabetes, by most estimates, is now the most common cause of liver disease. Cryptogenic cirrhosis, of which diabetes is, by far, the most common cause, has become the third leading indication for liver transplantation. A large study of patients with & without Type II DM followed up for 10 years showed that the incidence of non-alcoholic CLD and HCC was 2 fold greater in diabetic patients compared when compared with non-diabetic patients. In the population-based Verona study, cirrhosis was the fourth leading cause of death and accounted for 4.4% of diabetes-related deaths.

The standardized mortality ratio (SMR), for cirrhosis was 2.52 compared with 1.34 for cardiovascular disease (CVD). Thus the importance of liver disease in diabetics has been grossly under estimated.  

Virtually the entire spectrum of liver disease is seen in patients with diabetes. Diabetes causes increased risk of acute liver failure, chronic non-alcoholic fatty liver disease (NAFLD), cirrhosis, hepatocellular carcinoma (HCC) and mortality due to liver diseases. Insulin resistance is the key pathogenic mechanism leading to fat deposition in liver. Multiple other factors such as oxidative stress, mitochondrial dysfunction and circulating cytokines in diabetics contribute to disease progression. Diabetes is an independent risk factor for fibrosis which is key determinant of progressive liver disease. 20-25% of diabetic patients with steatosis progress to steatohepatitis (NASH), out of which about 20% further progress to cirrhosis over 10-15 years. Associated features of metabolic syndrome such as obesity, dyslipidaemia also add to risk and progression of early liver disease to liver fibrosis and cirrhosis.

Liver diseases related to diabetes (either caused or aggravated by) may be called diabetic hepatopathy.

Diabetic Hepatopathy - Association of Physicians of Indiaapiindia.org › uploads › pdf › medicine_update_2017