Preventing Severe Liver Disease in Diabetes with Dual Screening

Researchers from Karolinska Institutet in Sweden propose a dual screening method to address a critical health issue: preventing severe liver disease in diabetes. This study, published in Lancet Gastroenterology and Hepatology, highlights the benefits of combining liver fibrosis screening with routine eye screenings for individuals with type 2 diabetes.

The Overlap of Diabetes and Liver Disease
Over half of people with type 2 diabetes develop steatotic liver disease, commonly known as fatty liver disease. Often undetected in its early stages, this condition can progress to liver fibrosis, increasing the risk of cirrhosis or liver cancer. Guidelines now recommend screening at-risk patients, particularly those with type 2 diabetes, for liver fibrosis.

“Severe liver disease is frequently identified late, leaving few treatment options,” explains Dr. Hannes Hagström, adjunct professor at Karolinska Institutet. With an approved treatment for fatty liver disease with fibrosis now available, early detection could prevent severe outcomes.

Dual Screening for Better Outcomes
In Sweden, routine retina scans for eye damage in diabetes patients are well-established. The study investigated integrating liver fibrosis screening using elastography, a painless ultrasound technique that takes just 5–10 minutes.

Combining these screenings would allow earlier detection of liver fibrosis, potentially saving lives. The study involved over 1,300 diabetes patients undergoing eye exams, of whom 77% agreed to liver screening. Elastography results showed that 15.8% of participants had signs of liver fibrosis, with advanced fibrosis or cirrhosis in 5%. However, repeat exams suggested lower rates, likely due to non-fasting errors in initial tests.

Next Steps in Prevention
The researchers aim to assess the cost-effectiveness of this combined approach. If proven beneficial, this strategy could become a standard practice, preventing severe liver disease in diabetes while streamlining patient care.

This promising approach demonstrates how innovative methods can address overlapping health risks in diabetes, ultimately improving patient outcomes.

More information: Lindfors, A., et al. (2024) Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: a cross-sectional study. The Lancet Gastroenterology & Hepatology. doi.org/10.1016/s2468-1253(24)00313-3.