Abstract
Diabetes is a driver of non-alcoholic fatty liver disease (NAFLD) and fibrosis. We determine current practices in examining liver fibrosis in people with diabetes and record prevalence levels in primary and secondary care. We extracted HbA1c results ≥48 mmol/mol to identify people with diabetes, then examined the proportion who had AST, ALT, and platelets results, facilitating calculation of non-invasive fibrosis tests (NIT), or an enhanced liver fibrosis score. Fibrosis markers were requested in only 1.49% (390/26,090), of which 29.7% (n = 106) had evidence of significant fibrosis via NIT. All patients at risk of fibrosis had undergone transient elastography (TE), biopsy or imaging. TE and biopsy data showed that 80.6% of people with raised fibrosis markers had confirmed significant fibrosis. We also show that fibrosis levels as detected by NIT are marginally lower in patients treated with newer glucose lowering agents (sodium-glucose transporter protein 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists). In conclusion by utilising a large consecutively recruited dataset we demonstrate that liver fibrosis is infrequently screened for in patients with diabetes despite high prevalence rates of advanced fibrosis. This highlights the need for cost-effectiveness analyses to support the incorporation of widespread screening into national guidelines and the requirement for healthcare practitioners to incorporate NAFLD screening into routine diabetes care.
Highlights
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the UK and Europe [1], soon to become the most common indication for liver transplantation in the decade [2], as a result of the obesity and associated type 2 diabetes (T2D) epidemics
We further examined what proportion of individuals identified as being at risk of significant liver fibrosis according to non-invasive tests (NITs), had gone on to have confirmatory testing with either transient elastography (TE) or liver biopsy
We identified 26,090 individuals who had an HbA1c result ≥48 mmol/mol requested from primary care or secondary care
Summary
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the UK and Europe [1], soon to become the most common indication for liver transplantation in the decade [2], as a result of the obesity and associated type 2 diabetes (T2D) epidemics. Type 2 diabetes is a condition characterised by peripheral insulin resistance with inadequate compensatory pancreatic beta-cell insulin secretion. Insulin resistance and systemic inflammation lead to accumulation of free fatty acids and consequentially hepatocyte triglyceride accumulation characterising NAFLD [4,5]. NAFLD is generally benign in the majority of individuals, in up to 40% of people it can progress to liver fibrosis [6,7].
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