Fatty liver disease in type 2 diabetes: Common and often unmanaged

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Original Research

Fatty liver disease in type 2 diabetes: Common and often unmanaged

J Fam Pract. 2012 March;61(3):E5-E7

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References

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CORRESPONDENCE Eric L. Johnson, MD, 501 N. Columbia Road, Stop 9037, Grand Forks, ND 58202; eric.I.johnson@med.und.edu

A medical intervention was offered to 4 of the 11 patients (2 women and 2 men) who received a diagnosis of fatty liver disease. Practitioners specifically referred one woman for medical weight loss management and another for weight loss surgery. One man was advised to stop taking metformin, and another was referred to a dietician for lifestyle weight loss management. No patient was referred to a gastroenterologist or any other specialist for further evaluation or biopsy.

DISCUSSION

Although a small sample size limits the strength of this pilot study, the finding that fatty liver disease is common in patients with type 2 diabetes in a rural community hospital population supports other published data. As only half of the subjects with abnormal liver function tests had imaging studies, it’s likely that some patients in the study group who did not undergo imaging also had NAFLD, NASH, or other liver disease, but it was not diagnosed.

FAST TRACK

The high prevalence of fatty liver disease in this population of patients with type 2 diabetes supports earlier findings.

While no specific screening guidelines for fatty liver disease in patients with type 2 diabetes have been issued, clinical interest in this area has been growing, and this study suggests some avenues for further exploration.³ In the institution where this study was conducted, it appears that liver function tests were most likely to be performed in conjunction with routine monitoring of the use of statins, metformin, or other medications or because of a symptom such as abdominal pain. Yet given the widespread availability and relatively low cost of such tests, periodic monitoring of serum liver function in patients with type 2 diabetes may be warranted.¹⁴

Patients found to have persistent or recurrent abnormal liver function tests could then be referred for further evaluation with ultrasound, CT, or MRI.¹⁴ Ultrasound has the benefit of lower cost and avoidance of intravenous contrast, which may be important for patients with renal dysfunction.¹⁴ Based on the results of these tests, appropriate medical interventions could then follow.

·Acknowledgements·

The author thanks Bonnie Lee and Diane Vold for their assistance in the design of this study and its preparation for publication. The author also thanks William Zaks, MD, PhD, and James Brosseau, MD, MPH, for their guidance and feedback.