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20 May 2019, 07:19
People living with type 2 diabetes are at higher risk of liver disease, a study found.
Many patients with potentially deadly liver cirrhosis and liver cancer are being diagnosed at late, advanced, stages of the disease, according to a study led by Queen Mary University of London and the University of Glasgow.
The study of 18 million people across Europe suggests people living with type 2 diabetes are at particular risk of this "silent disease" and should be monitored closely to prevent life-threatening disease progression.
Non-alcoholic fatty liver disease (NAFLD) affects up to a quarter of people in the West and is the most common cause of liver disease around the world.
It is closely associated with obesity and type 2 diabetes, and GPs are often unaware of the condition and patients often go undiagnosed, Queen Mary University of London said.
For the majority, NAFLD is a benign condition, but one in six people will go on to develop the aggressive form of the disease, called non-alcoholic steatohepatitis (NASH), leading to liver injury, scarring and eventually in some to cirrhosis, liver failure and even liver cancer.
By identifying which patients might go on to develop the more aggressive disease, interventions and treatments could be targeted at those in greatest need.
In the largest study of its kind, published in the journal BMC Medicine, the team combined the healthcare records of 18 million European adults from the UK, Netherlands, Italy and Spain.
They matched each NAFLD patient to 100 patients who did not have a recorded diagnosis, and looked to see who developed liver cirrhosis and liver cancer over time.
More than 136,000 patients were identified with NAFLD/NASH and were more likely to have type 2 diabetes, hypertension and obesity than matched controls.
The strongest association was observed in NAFLD/NASH patients who had a diagnosis of type 2 diabetes - they were more than twice as likely to develop aggressive liver disease.
This suggests that diabetes could be a good predictor of liver disease progression.
Lead researcher Dr William Alazawi, from Queen Mary University of London, said: "We were surprised that the number of patients with recorded diagnoses of non-alcoholic fatty liver was much less than expected, meaning that many patients are actually undiagnosed in primary care.
"Even over the short time frame of the study, some patients progressed to more advanced, life-threatening stages of disease, suggesting that they are being diagnosed very late.
"The public, doctors and policymakers need to be aware of this silent disease and strategies need to be put in place to tackle the root causes and avoid progression to life-threatening stages.
"People living with diabetes are at increased risk of more advanced, life threatening stages of disease, suggesting that we should be focusing our efforts in educating and preventing liver disease in diabetes patients."