Clinical care pathway to detect advanced liver disease in patients with type 2 diabetes through automated fibrosis score calculation and electronic reminder messages: a randomised controlled trial
Open accessAbstract
OBJECTIVE: We aimed to test the hypothesis that automated fibrosis score calculation and electronic reminder messages could increase the detection of advanced liver disease in patients with type 2 diabetes. DESIGN: In this pragmatic randomised controlled trial at five general medical or diabetes clinics in Hong Kong and Malaysia, we randomly assigned patients in a 1:1 ratio to the intervention group with Fibrosis-4 index and aspartate aminotransferase-to-platelet ratio index automatically calculated based on routine blood tests, followed by electronic reminder messages to alert clinicians of abnormal results, or the control group with usual care. The primary outcome was the proportion of patients with increased fibrosis scores who received appropriate care (referred for hepatology care or specific fibrosis assessment) within 1 year. RESULTS: Between May 2020 and Oct 2021, 1379 patients were screened, of whom 533 and 528 were assigned to the intervention and control groups, respectively. A total of 55 out of 165 (33.3%) patients with increased fibrosis scores in the intervention group received appropriate care, compared with 4 of 131 (3.1%) patients in the control group (difference 30.2% (95% CI 22.4% to 38%); p<0.001). Overall, 11 out of 533 (2.1%) patients in the intervention group and 1 out of 528 (0.2%) patients in the control group were confirmed to have advanced liver disease (difference 1.9% (95% CI 0.61% to 3.5%); p=0.006). CONCLUSION: Automated fibrosis score calculation and electronic reminders can increase referral of patients with type 2 diabetes and abnormal fibrosis scores at non-hepatology settings. TRIAL REGISTRATION NUMBER: NCT04241575.
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A recent RCT at general medical and diabetes clinics showed that automated fibrosis score calculation followed by reminder messages in the electronic health system could increase referral of individuals with increased fibrosis scores to hepatologists for specific fibrosis testing from 3% to 33%.
“A recent RCT at general medical and diabetes clinics showed that automated fi brosis score calculation followed by reminder messages in the electronic health system could increase the referral of individuals with increased fi brosis scores to hepatologists for speci fi c fi brosis testing (from 3% to 33%).”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [128]
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Algorithms for Risk Stratification in Patients with Metabolic Dysfunction-Associated Steatohepatitis
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- Authors
- Zhang, X., Yip, T. C.-F., Wong, G. L.-H., Leow, W.-X., Liang, L. Y., Lim, L.-L., Li, G., Ibrahim, L., Lin, H., Lai, J. C. T., Chim, A. M.-L., Chan, H. L. Y., Kong, A. P.-S., Chan, W. K., & Wong, V. W.-S.
- Affiliations
- Chinese University of Hong Kong (HK)
- University of Malaya (MY)
- Union Hospital (HK)
- Corresponding author
- Wong, Vincent Wai-Sun
- ORCID
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2023-08-07
- Volume
- 72
- Issue
- 12
- Pages
- 2364-2371
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC10715546
- OpenAlex
- W4385625560
- Cited by
- 55
- References
- 34
- Citations by year
- 2026: 15 · 2025: 19 · 2024: 17 · 2023: 4
- FWCI
- 10.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gut (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- The Chinese University of Hong Kong (2021.027)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Keywords
- type 2 diabetes, advanced liver disease, liver fibrosis, FIB-4, aspartate aminotransferase to platelet ratio index, care pathways, hepatology referral, diabetes screening
- MeSH terms
- Diabetes Mellitus, Type 2, Digestive System Diseases, Fibrosis, Humans, Liver Cirrhosis, Liver Diseases, Critical Pathways, Non-alcoholic Fatty Liver Disease
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