ADA now Recommends Screening for Liver Disease

Larry Greenblatt, MD

The American Diabetes Association (ADA) now recommends that everyone with type 2 diabetes and prediabetes should be screened for fatty liver disease—also called metabolic dysfunction-associated steatotic liver disease (MASLD) or non-alcoholic fatty liver disease (NAFLD). This screening is important because up to 70% of people with type 2 diabetes might have liver disease. Fatty liver disease, especially the kind not caused by alcohol, is common in these individuals and can lead to serious problems like cirrhosis and liver cancer. The ADA's new guidelines were announced at their annual 2023 Scientific Sessions and are also published in a diabetes care update.

The ADA's decision to recommend universal screening comes at a time when liver issues are becoming a major concern for people with type 2 diabetes. MASLD in particular is now the leading cause of liver problems like cirrhosis and the need for liver transplants in the United States. This change is reflected in the ADA's updated standards for diabetes care. Other professional groups, including the American Association for the Study of Liver Diseases, also agree with this approach.

For screening, the ADA suggests using a tool called the FIB-4 index. This index looks at the patient’s age, liver enzymes, and blood platelet count to assess the risk of liver fibrosis. A high score on this test indicates a greater risk. The FIB-4 index is seen as a better tool than just checking liver enzymes, which can miss many cases of liver disease in people with type 2 diabetes. The ADA also advises that this screening should be straightforward to do with electronic health records. The system used by Duke Health and Lincoln Community Health Center allows for easy calculation of the FIB-4 index.  Individuals found to be at higher risk should get a more definitive test-liver elastography, a specialized liver ultrasound.

Finally, the ADA recommends lifestyle changes for everyone with diabetes or prediabetes and NAFLD, especially if they are overweight or obese. The ADA also suggests considering certain medications—like GLP-1 agonists or pioglitazone—for those with serious liver issues. The ADA advises using statins to manage cardiovascular risk in these patients, except in cases of advanced cirrhosis. This new focus on fatty liver disease in diabetes care is seen as a significant step forward.

For more information: https://www.medscape.com/viewarticle/993715?form=fpf#vp_1