Dipartimento di Medicina e Riabilitazione, Policlinico di Monza, Via Amati 111, 20900, Monza, MB, Italy.
Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano Bicocca, Milan, MI, Italy.
J Endocrinol Invest. 2018 May;41(5):509-521. doi: 10.1007/s40618-017-0799-3. Epub 2017 Nov 30.
Type 2 diabetes may reduce life expectancy and patients' quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.
2 型糖尿病可能会降低预期寿命和患者的生活质量，这是由于其微血管和大血管并发症，以及几种类型癌症的风险较高所致。一个新兴的重要因素是肝脏受累；人们认识到，肝内脂肪过度积累是糖尿病患者的典型特征，它也起着重要的致病作用。现在已经很明显，非酒精性脂肪性肝病（NAFLD）通常被认为是一种良性疾病，但实际上可能对糖尿病患者产生重要的有害影响，增加了发生心血管并发症的风险，还会导致严重的肝脏疾病，特别是非酒精性脂肪性肝炎（NASH）、肝硬化和肝细胞癌。生活方式干预、减肥手术和几种药物治疗方法现在已经积累了治疗 NASH 的疗效证据。另一方面，它们在长期的耐久性和安全性仍有待证明，其使用有时可能会与副作用或更高的不良事件风险相关，从而限制了常规给药或禁止使用。专业的医疗保健提供者应该提高对这些肝脏并发症重要性的认识，通过行为疗法进行初级预防，需要采用多学科方法，在临床环境中定期应用现有的预测算法，以识别心血管和肝脏风险较高的患者，进行二级预防，并在没有禁忌症的情况下，优先对糖尿病患者进行具有 NAFLD/NASH 获益证据的药物治疗。
