Abstract
Background: Type 2 diabetes is an independent risk factor for chronic liver disease, however disease burden estimates and knowledge of prognostic indicators are lacking in community populations.Aims: To describe the prevalence and incidence of clinically significant chronic liver disease amongst community-based older people with Type 2 diabetes and to determine risk factors which might assist in discriminating patients with unknown prevalent or incident disease.Design: Prospective cohort study.Methods: Nine hundred and thirty-nine participants in the Edinburgh Type 2 Diabetes Study underwent investigation including liver ultrasound and non-invasive measures of non-alcoholic steatohepatitis (NASH), hepatic fibrosis and systemic inflammation. Over 6-years, cases of cirrhosis and hepatocellular carcinoma were collated from multiple sources.Results: Eight patients had known prevalent disease with 13 further unknown cases identified (prevalence 2.2%) and 15 incident cases (IR 2.9/1000 person-years). Higher levels of systemic inflammation, NASH and hepatic fibrosis markers were associated with both unknown prevalent and incident clinically significant chronic liver disease (all P < 0.001).Conclusions: Our study investigations increased the known prevalence of clinically significant chronic liver disease by over 150%, confirming the suspicion of a large burden of undiagnosed disease. The disease incidence rate was lower than anticipated but still much higher than the general population rate. The ability to identify patients both with and at risk of developing clinically significant chronic liver disease allows for early intervention and clinical monitoring strategies. Ongoing work, with longer follow-up, including analysis of rates of liver function decline, will be used to define optimal risk prediction tools.
Highlights
Chronic liver disease (CLD) due to non-alcoholic fatty liver disease (NAFLD) in community populations represents a major challenge for general practitioners and a growing burden for healthcare services.[1]
Of the 25% of the UK population categorized as obese, most will have NAFLD2 and $10% of these people have been diagnosed in community studies to have evidence of advanced liver fibrosis that leads to cirrhosis.[3]
The prevalence of clinically significant CLD (CS-CLD) at baseline was 2.2% (0.9% diagnosed clinically prior to enrolment and 1.4% identified by study investigations)
Summary
Chronic liver disease (CLD) due to non-alcoholic fatty liver disease (NAFLD) in community populations represents a major challenge for general practitioners and a growing burden for healthcare services.[1] Of the 25% of the UK population categorized as obese, most will have NAFLD2 and $10% of these people have been diagnosed in community studies to have evidence of advanced liver fibrosis that leads to cirrhosis.[3] Of patients with cirrhosis (all cause), 5–20% will develop hepatocellular carcinoma (HCC) in 5 years.[4] Type 2 diabetes, which is increasing in frequency in parallel with obesity, is strongly associated with NAFLD but data on the progression to cirrhosis and HCC in community-based patients with diabetes is limited. The existing diagnostic pathways for detection and onward referral of suspected CLD are based on traditional liver enzyme tests which lack accuracy and contribute to late diagnosis
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