Translational Gastroenterology Unit, NIHR Oxford Biomedical Research Centre, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, UK.
Diabet Med. 2018 Jan;35(1):89-98. doi: 10.1111/dme.13540.
To define the attitudes and current clinical practice of diabetes specialists with regard to non-alcoholic fatty liver disease and, based on the results, implement an evidenced-based pathway for non-alcoholic fatty liver disease assessment.
An online survey was disseminated to diabetes specialists. Based on findings from this survey, we sought a local solution by launching an awareness campaign and implementing a screening algorithm across all diabetes clinics at a secondary/tertiary referral centre.
A total of 133 diabetes specialists responded to the survey. Fewer than 5% of responders correctly assessed the prevalence and severity of advanced fibrotic non-alcoholic fatty liver disease in people with diabetes as 50-75%. Whilst most clinicians performed liver function tests, only 5.7% responded stating that they would use, or had used, a non-invasive algorithm to stage the severity of non-alcoholic fatty liver disease. Implementing a local non-alcoholic fatty liver disease awareness campaign and screening strategy using pre-printed blood request forms, we ensured that 100% (n=395) of all people with Type 1 and Type 2 diabetes mellitus attending secondary/tertiary care diabetes clinics over a 6-month period were appropriately screened for advanced fibrotic non-alcoholic fatty liver disease using the Fib-4 index; 17.9% required further investigation or assessment.
The prevalence and severity of non-alcoholic fatty liver disease are underestimated among diabetes specialists. The Fib-4 index can easily be incorporated into clinical practice in secondary/tertiary care to identify those individuals at risk of advanced fibrosis who require further assessment and who may benefit from a dedicated multidisciplinary approach to their management.
定义糖尿病专家对非酒精性脂肪性肝病的态度和当前临床实践，并基于结果，实施针对非酒精性脂肪性肝病评估的循证途径。
我们向糖尿病专家发放了在线调查。根据这项调查的结果，我们通过在二级/三级转诊中心的所有糖尿病诊所发起一项提高认识的运动和实施一种筛选算法，寻求当地的解决方案。
共有 133 名糖尿病专家对该调查做出了回应。不到 5%的应答者正确评估了糖尿病患者中进展性纤维化非酒精性脂肪性肝病的流行率和严重程度为 50-75%。尽管大多数临床医生进行了肝功能检查，但只有 5.7%的应答者表示他们会使用或已经使用非侵入性算法来分期非酒精性脂肪性肝病的严重程度。通过实施一项当地的非酒精性脂肪性肝病提高认识运动和使用预印血样申请单的筛选策略，我们确保在 6 个月的时间内，二级/三级保健糖尿病诊所就诊的所有 1 型和 2 型糖尿病患者中，有 100%（n=395）都使用 Fib-4 指数进行了适当的进展性纤维化非酒精性脂肪性肝病筛查；17.9%的患者需要进一步检查或评估。
糖尿病专家对非酒精性脂肪性肝病的流行率和严重程度估计不足。Fib-4 指数可以很容易地纳入二级/三级保健的临床实践中，以识别那些有进展性纤维化风险的个体，这些人需要进一步评估，并且可能受益于专门的多学科方法来管理他们的病情。
