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Surveillance of the liver in type 2 diabetes: important but unfeasible? – published online 09/02/2024

Qadri graphical abstract

Sami Qadri, Hannele Yki‑Jarvinen

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a bourgeoning health issue that disproportionately affects people with type 2 diabetes. Liver fat accumulation is not merely a marker of metabolic abnormalities; it precedes and predicts progressive liver disease. However, there is significant uncertainty regarding who should be targeted for liver-related evaluations and the best methods for doing so. In this issue, Qadri and Yki-Järvinen (https://doi.org/10.1007/s00125–024–06087–7) provide a critical review of recent evidence on the importance, feasibility and methods of monitoring MASLD in type 2 diabetes. The authors highlight that, although MASLD is common among individuals with diabetes, the prevalence of advanced liver fibrosis is likely to be overestimated. Recent guidelines recommend universal fibrosis screening in type 2 diabetes, but the evidence base and appropriate tools are lacking. The proposed screening algorithms are expected to channel 20% of all individuals with diabetes to tertiary care, with a false discovery rate as high as 80%. The authors conclude that fibrosis case-finding strategies should be thoroughly reassessed and that more effective approaches to surveying the liver in type 2 diabetes are needed. The figures from this review are available as a downloadable slideset.

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