Non-alcoholic fatty liver disease in patients with type two diabetes: A retrospective review of management and outcomes over a five year period
A Kearney1, J McGoran2, AG Nugent1
Departments of Endocrinology1 and Gastroenterology2, Belfast City Hospital, Belfast UK.
Non-alcoholic fatty liver disease (NAFLD) is the commonest cause of chronic liver disease worldwide. The clinical syndromes range from simple steatosis to non-alcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma. Insulin resistance and the metabolic syndrome, which are strongly associated with type two diabetes and obesity, have been implicated in the pathogenesis and disease progression of NAFLD. Treatment strategies include weight loss and managing insulin resistance. The effects of metformin on NAFLD are mixed but more promising results have been observed with thiazolidinediones and glucagonlike peptide-1 (GLP-1) agonists. Cardiovascular disease and NAFLD are strongly associated and statin therapy is urged having been shown to improve hepatic biochemical and histological scores.
We analysed the management and outcomes of patients with type two diabetes and NAFLD over a five year period.
A retrospective analysis of 46 patients with type two diabetes who were diagnosed with NAFLD between January 2008 and December 2013 in the Belfast Trust was performed. Data recorded included body mass index (BMI), glycated haemoglobin (HbA1c), statin use and diabetic therapy. Outcomes measured included progression to cirrhosis, cardiovascular events and mortality.
The mean length of follow up was 44 months at the time of data collection. At diagnosis of NAFLD the mean BMI and HbA1c were 33.8kg/m2 and 67.9mmol/mol respectively. BMI averaged 34.5kg/m2 and HbA1c 61.5mmol/mol at the end of our follow up period. Statins were prescribed in 54.3%. Metformin, thiazolidinediones and GLP-1 agonists were prescribed in 33, 3 and 1 case respectively. Twenty-two patients (47.8%) progressed to cirrhosis and the mean age at diagnosis of cirrhosis was 59.4 years. Twelve patients (26.1%) had confirmed cirrhosis within one year of presentation with NAFLD. Cardiovascular events occurred in 13% and mortality in 19.6%.
Co-existing type two diabetes and NAFLD carries a high risk of morbidity and mortality with high rates of progression to cirrhosis observed. The prevalence of NAFLD is expected to increase significantly over the coming years making aggressive strategies including weight loss and reducing cardiovascular risk profile essential in its management.