Division of Endocrinology and Diabetes, Medanta the Medicity Hospital, Gurugram, 122001, Haryana, India.
Hepatology, Medanta the Medicity Hospital, Gurugram, 122001, Haryana, India.
Diabetes Metab Syndr. 2020 Nov-Dec;14(6):2233-2239. doi: 10.1016/j.dsx.2020.11.015. Epub 2020 Nov 19.
Type 2 diabetes (T2D) and nonalcoholic fatty liver disease (NAFLD) often exist together. This is a high-risk population, as presence of T2D promotes the progression of NAFLD to more severe liver pathologies. There are several international guidelines for managing T2D, however guidance for management of NAFLD in individuals with T2D is scarce. In India, there is hardly any screening programme for identification of high-risk NAFLD individuals.
A literature search was performed with Medline (PubMed), Scopus and Google Scholar electronic databases till October 2020, using relevant keywords (nonalcoholic fatty liver disease; NAFLD; nonalcoholic steatohepatitis; NASH screening and management; metabolic associated fatty liver disease) to extract relevant studies describing screening and management strategies of NAFLD/NASH, especially in patients with T2D.
An estimated 12.4 million Indian people are living with coexisting T2D and NAFLD-related advanced liver fibrosis, which is a major determinant of liver-related mortality in these individuals. Several studies have reported screening tools for identification of high risk NAFLD patients with coexisting T2D. The emphasis has been laid on the identification of advanced liver fibrosis and cirrhosis, using noninvasive tests at the primary level. For management, lifestyle measures and appropriate glucose-lowering medication have been proposed that help patients with coexisting T2D and NAFLD. Timely referral to specialists is also critical for preventing complications of cirrhosis.
While current management algorithms for T2D include atherosclerotic cardiovascular disease, kidney dysfunction and obesity as co-morbidities to direct appropriate therapies, NAFLD should be considered as additional pathway to select appropriate treatment.
2 型糖尿病（T2D）和非酒精性脂肪性肝病（NAFLD）常同时存在。由于 T2D 会促进 NAFLD 向更严重的肝脏病变进展，因此这是一个高危人群。有几种国际指南用于管理 T2D，但针对 T2D 患者的 NAFLD 管理指南却很少。在印度，几乎没有任何针对高危 NAFLD 个体的筛查计划。
我们使用 Medline（PubMed）、Scopus 和 Google Scholar 电子数据库进行了文献检索，检索时间截至 2020 年 10 月，使用了相关关键词（非酒精性脂肪性肝病；NAFLD；非酒精性脂肪性肝炎；NASH 筛查和管理；代谢相关脂肪性肝病）来提取描述 NAFLD/NASH 筛查和管理策略的相关研究，特别是在 T2D 患者中。
据估计，有 1240 万印度人同时患有 T2D 和与 NAFLD 相关的晚期肝纤维化，这是这些患者发生与肝脏相关死亡的主要决定因素。有几项研究报道了用于识别同时患有 T2D 的高危 NAFLD 患者的筛查工具。重点是在初级水平使用非侵入性检测来识别晚期肝纤维化和肝硬化。在管理方面，建议采取生活方式措施和适当的降糖药物，这有助于同时患有 T2D 和 NAFLD 的患者。及时转介给专科医生对于预防肝硬化并发症也至关重要。
虽然目前 T2D 的管理算法将动脉粥样硬化性心血管疾病、肾功能不全和肥胖作为合并症纳入其中，以指导进行适当的治疗，但应将 NAFLD 视为选择适当治疗方法的另一种途径。
