Mechanisms, screening modalities and treatment options for individuals with non‐alcoholic fatty liver disease and type 2 diabetes
Abstract
Non‐alcoholic fatty liver disease (NAFLD) exists as a spectrum of disease ranging from excessive accumulation of fat within the liver (simple steatosis), inflammation (non‐alcoholic steatohepatitis) through to fibrosis, cirrhosis and end‐stage liver disease. There is also an increased risk of hepatocellular carcinoma. The principal risk factor for NAFLD is overweight or obesity, along with type 2 diabetes, and NAFLD itself is also a risk factor for incident type 2 diabetes. Overweight/obesity is synergistic with alcohol consumption in causing progressive and insidious liver damage. Recent consensus advocates a change in nomenclature from NAFLD to ‘metabolic associated fatty liver disease’ (MAFLD), reflective of the associated metabolic abnormalities (insulin resistance/type 2 diabetes and metabolic syndrome components). Additional extra‐hepatic manifestations of NAFLD include cardiovascular disease, chronic kidney disease and certain cancers. Unlike other micro‐ and macrovascular complications of type 2 diabetes, systematic screening or surveillance protocols have not been widely adopted in routine diabetes care to assess for presence/severity of NAFLD. Various screening tools are available (non‐invasive tests and biochemical indices) combined with imaging techniques (e.g. transient elastography) to detect steatosis and more importantly advanced fibrosis/cirrhosis to facilitate appropriate surveillance. Liver biopsy may be sometimes necessary. Treatment options for type 2 diabetes, including lifestyle interventions (dietary change and physical activity), glucose‐lowering therapies and metabolic surgery, can modulate hepatic steatosis and to a lesser extent fibrosis. Awareness of the impact of liver disease on the choice of glucose‐lowering medications in individuals with type 2 diabetes is also critical.
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Once MASLD progresses beyond steatosis to steatohepatitis with fibrosis, there is substantial risk of cirrhosis, liver failure, and hepatocellular carcinoma.
“Once MASLD progresses beyond steatosis to steatohepatitis with fibrosis, there is substantial risk of cirrhosis, liver failure, and hepatocellular carcinoma.124,125”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [125]
The presence of MASLD is associated with a higher risk of type 2 diabetes and cardiovascular disease.
“The presence of MASLD is also associated with a higher risk of type 2 diabetes (and is present in ~70% of people with type 2 diabetes) and cardiovascular disease.125”
From Definition and diagnostic criteria of clinical obesity (2025) · cites this paper as [125]
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- Authors
- Hydes, T. J., Summers, N., Brown, E., Alam, U., Thomaides‐Brears, H., Wilding, J. P. H., & Cuthbertson, D. J.
- Affiliations
- University Hospital Southampton NHS Foundation Trust (GB)
- Aintree University Hospitals NHS Foundation Trust (GB)
- University of Liverpool (GB)
- Perpsectum Gemini One Oxford UK
- Corresponding author
- Hydes, T. J.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2020-07-13
- Volume
- 37
- Issue
- 11
- Pages
- 1793-1806
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W3040248250
- Cited by
- 21
- References
- 50
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 3
- FWCI
- 0.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- non-alcoholic fatty liver disease, type 2 diabetes, metabolic-associated fatty liver disease, NAFLD screening, liver fibrosis, liver cirrhosis, hepatocellular carcinoma, obesity, insulin resistance, metabolic syndrome, transient elastography, liver biopsy, glucose-lowering therapy, metabolic surgery, lifestyle intervention, cardiovascular risk, chronic kidney disease, extrahepatic manifestations
- MeSH terms
- Glucagon-Like Peptide-1 Receptor, Sodium-Glucose Transporter 2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, Alanine Transaminase, Aspartate Aminotransferases, Biopsy, Diabetes Mellitus, Type 2, Diet Therapy, gamma-Glutamyltransferase, Humans, Hypoglycemic Agents, Liver, Magnetic Resonance Imaging, Mass Screening, Obesity, Platelet Count, Risk Factors, Severity of Illness Index, Exercise, Metabolic Syndrome, Thiazolidinediones, Bariatric Surgery, Elasticity Imaging Techniques, Non-alcoholic Fatty Liver Disease
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