Abstract
There is a bidirectional relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). The liver has a vital role in the pathophysiology of both diseases as it leads to the development of insulin resistance (IR), which in turn results in NAFLD and T2DM. It has been shown that T2DM increases the risk of NAFLD progression. Furthermore, the presence of NAFLD raises the probability of T2DM complications, which explains the increased rates of NAFLD screening in patients with T2DM. In addition, there are common management options for the two diseases. Lifestyle changes can play a role in the initial management of both diseases. Medications that are used to treat T2DM are also used in the management of NAFLD, such as metformin, thiazolidinediones (TZD), glucagon-like peptide-1 (GLP-1) analogues, and dipeptidyl peptidase-4 (DPP4) inhibitors. Bariatric surgery is often used as a last resort and has shown promising results. Lifestyle interventions with diet and exercise are important postoperatively to maintain the weight loss. There are many novel treatments that are being investigated for the treatment of NAFLD, targeting multiple pathophysiologic pathways. This review aims to shed some light on the intricate relationship between NAFLD and T2DM and how IR links both diseases. We also try to raise awareness among clinicians about this relationship and how the presence of one disease should raise a high index of suspicion for the existence of the other.
Highlights
BackgroundNon-alcoholic fatty liver disease (NAFLD) is a range of liver disorders that includes hepatic steatosis, steatohepatitis, and hepatic fibrosis
Studies have shown that type 2 diabetes mellitus (T2DM) plays a major role in disease progression to non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis [8]
In a prospective cross-sectional study, 679 patients with a confirmed diagnosis of T2DM were screened for non-alcoholic fatty liver disease (NAFLD) using transient elastography, and the findings showed a prevalence of 83.6% of NAFLD
Summary
Non-alcoholic fatty liver disease (NAFLD) is a range of liver disorders that includes hepatic steatosis, steatohepatitis, and hepatic fibrosis. There has been much debate about the routine use of liver biopsy for diagnosing NAFLD, considering its invasiveness, even though it remains the gold standard of diagnosis It is recommended for confirming the diagnosis of NASH, monitoring patients with a high risk of disease progression, persistent elevation of liver enzymes for more than six months, excluding other causes of chronic liver diseases, and inconclusive imaging [63,64]. Several studies consisting of morbidly obese NAFLD patients have revealed positive outcomes with bariatric surgery: reduction in steatosis, lobular inflammation, ballooning, and fibrosis [126,127] When it comes to the comparison between the efficacy of different types of bariatric surgery, RYGB appears to be superior to all others due to its excellent weight-loss effects [128]. ASK1: apoptosis signal-regulating kinase 1; FXR: farnesoid X receptor; NAFLD: non-alcoholic fatty liver disease; NASH: non-alcoholic steatohepatitis; F3, STELLAR III: patients with NASH and bridging fibrosis; F4, STELLAR IV: patients with compensated cirrhosis
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