Non-alcoholic fatty liver disease (NAFLD) presents with hepatic steatosis not caused by alcohol intake. It may also progress to steatohepatitis, cirrhosis and ultimately liver failure.

NAFLD shows a high prevalence in type 2 diabetes mellitus (T2DM) and can also occur in type 1 DM (T1DM). T2DM patients have an increased risk of NAFLD due to a higher prevalence of obesity and insulin resistance. Alanine aminotransferase is increased by 2times in 20% of children with T2DM, and this is attributed in most cases to NAFLD.

While examining associations between DM and NAFLD, not only the occurrence of NAFLD with diabetes must be considered but also the effects of diabetes on NAFLD progression to NASH.

In obese diabetic patients, NAFLD can be prevented and treated effectively by weight reduction attained by diet and exercise. Bariatric surgery can also be used to reverse NAFLD in T2DM. Recently certified medications for weight loss demands assessment regarding their impact on the development and progression of NAFLD. 

Some drugs used for blood glucose control in T2DM [thiazolidinediones (TZDs), glucagon-like peptide-1 (GLP-1) analogs, and dipeptidyl peptidase-4 (DPP-4) inhibitors] and also statins might also help to prevent or treat NAFLD in patients with diabetes.

There exists no recommendation to routinely screen NAFLD in patients with diabetes or increased risk in the absence of elevated liver transaminases or other evidence for liver disease. 

The rate of progression from simple steatosis (NAFL) to steatosis with associated inflammation and fibrosis (NASH) is quite low, thus screening for NAFL is only important if effective pharmacological agents are recognized that have low cost and highly favorable adverse event profiles. Since NASH progresses more frequently to serious liver disease, screening NASH would be cost-effective even for costly medications and those having less favorable side effect profiles. 

Source: Bhatt HB, Smith RJ. Fatty liver disease in diabetes mellitus. Hepatobiliary Surg Nutr. 2015;4(2):101-108. doi:10.3978/j.issn.2304-3881.2015.01.03