Abstract
Nonalcoholic fatty liver disease (NAFLD) and its complications disproportionately impact individuals with T2DM. NAFLD prevalence is thought to be 60-70% in T2DM. In response to this, guidelines now recommend additional liver testing and risk stratification of NAFLD in patients with T2DM who have elevated liver enzymes or steatosis seen on ultrasound. In this secondary analysis of data from a randomized trial of a telehealth intervention, we investigated NAFLD testing and care patterns in a cohort of Veterans with poor T2DM control across two VA sites (n=244) over a 2-year period (2018-2020). Mean HbA1c and BMI were 9.8% (SD 1.5%) and 35.0 kg/m2 (SD 6.3), respectively. Only 6.6% (n=16) had a documented diagnosis of NAFLD. Excluding those with known NAFLD or other liver diseases (i.e., hepatitis B/C [n=14], alcohol overuse [n=6]), the majority of patients had documented liver enzyme (87%, n=184) and platelet (89%, n=187) testing. Based on established lab criteria for NAFLD diagnosis (i.e., at least two ALT ≥ 40 IU/mL in men, ≥ 31 IU/mL in women, ≥ 6 months apart), 17% (n=36) had undiagnosed NAFLD. Despite available lab data, no patients had a lab-based risk stratification score (such as the fibrosis-4 index or NAFLD fibrosis score) documented in clinical notes or electronic problem lists. Only 7% of patients had undergone liver ultrasound (n=15) and 2.4% Fibroscan (n=5), which are the usual first-line imaging modalities for diagnosis and risk stratification of NAFLD, respectively. Of patients with persistently elevated liver enzymes (n=36), only 14% (n=5) were referred to Hepatology. In summary, this study highlights the underrecognition of NAFLD in T2DM, even in patients with poor glycemic control and obesity who are exceedingly high risk of NAFLD complications. Since Endocrinologists commonly see patients with high metabolic risk, this study also highlights an important role for Endocrinologists in the proactive detection and risk stratification of NAFLD in T2DM. Disclosure A. Alexopoulos: None. R. Duffy: None. E. A. Kobe: None. C. A. Moylan: None. A. S. Jeffreys: None. C. Coffman: None. D. Soliman: None. J. German: None. M. Crowley: None.
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.