Low Screening Rates Despite a High Prevalence of Significant Liver Fibrosis in People with Diabetes from Primary and Secondary Care

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.

Ultrasound-Based Hepatic Elastography in Non-Alcoholic Fatty Liver Disease: Focus on Patients with Type 2 Diabetes

“…Preliminary results of an ongoing cross-sectional trial reported that less than 2% of patients with diabetes are screened for liver fibrosis in primary and secondary care. A high proportion of cases in which liver fibrosis was confirmed (80.6%) were identified using serum fibrosis markers associated with TE or liver biopsy [ 138 ]. On the other hand, in the cross-sectional study by Park et al, the patients with diabetes benefited from fibrosis screening procedures in primary care, even in the absence of steatosis [ 139 ].…”

“…Unfortunately, the screening rate is low in this high-risk population, despite the high prevalence of significant liver fibrosis and steatosis among patients with diabetes [ 138 ]. Therefore, the systematic implementation of a routine screening algorithm is needed to improve the clinical care of patients with NAFLD and diabetes.…”

A prospective study on the prevalence of MASLD in people with type‐2 diabetes in the community. Cost effectiveness of screening strategies

“…Furthermore, there is still a debate on whether screening might be cost‐effective in this population 8 . Finally, despite the most recent diabetes management guidelines suggesting to screen diabetics for MASLD, 13 the overall awareness among diabetologists remains low 14 …”

Implementing the right care in the right place at the right time for non-alcoholic fatty liver disease (NAFLD-RRR study): a study protocol for a community care pathway for people with type 2 diabetes

“…Although the leading causes of death are cardiovascular disease and extrahepatic malignancy, 5–10% of people with NAFLD develop complications of advanced liver disease over 10 to 20 years [ 5 , 6 ]. Among people with T2D, up to one third (15–30%) are at risk of clinically significant fibrosis [ 7 – 9 ] and there is a more than 2-fold increased risk of cirrhosis-related complications and liver disease mortality [ 10 ]. As a result, there is increasing recognition that an assessment of NAFLD and the severity of liver disease needs to be incorporated into the routine care of patients with T2D [ 7 , 9 , 11 ].…”