Padda Jaskamal, Khalid Khizer, Khedr Anwar, Tasnim Fahriba, Al-Ewaidat Ola A, Cooper Ayden Charlene, Jean-Charles Gutteridge
Internal Medicine, JC Medical Center, Orlando, USA.
Internal Medicine, Advent Health & Orlando Health Hospital, Orlando, USA.
Cureus. 2021 Aug 20;13(8):e17321. doi: 10.7759/cureus.17321. eCollection 2021 Aug.
There is a bidirectional relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM). The liver has a vital role in the pathophysiology of both diseases as it leads to the development of insulin resistance (IR), which in turn results in NAFLD and T2DM. It has been shown that T2DM increases the risk of NAFLD progression. Furthermore, the presence of NAFLD raises the probability of T2DM complications, which explains the increased rates of NAFLD screening in patients with T2DM. In addition, there are common management options for the two diseases. Lifestyle changes can play a role in the initial management of both diseases. Medications that are used to treat T2DM are also used in the management of NAFLD, such as metformin, thiazolidinediones (TZD), glucagon-like peptide-1 (GLP-1) analogues, and dipeptidyl peptidase-4 (DPP4) inhibitors. Bariatric surgery is often used as a last resort and has shown promising results. Lifestyle interventions with diet and exercise are important postoperatively to maintain the weight loss. There are many novel treatments that are being investigated for the treatment of NAFLD, targeting multiple pathophysiologic pathways. This review aims to shed some light on the intricate relationship between NAFLD and T2DM and how IR links both diseases. We also try to raise awareness among clinicians about this relationship and how the presence of one disease should raise a high index of suspicion for the existence of the other.
非酒精性脂肪性肝病（NAFLD）与2型糖尿病（T2DM）之间存在双向关系。肝脏在这两种疾病的病理生理学中起着至关重要的作用，因为它会导致胰岛素抵抗（IR）的发展，进而引发NAFLD和T2DM。研究表明，T2DM会增加NAFLD进展的风险。此外，NAFLD的存在会增加T2DM并发症的发生概率，这也解释了T2DM患者中NAFLD筛查率升高的原因。此外，这两种疾病有一些共同的管理方法。生活方式的改变在这两种疾病的初始管理中都能发挥作用。用于治疗T2DM的药物也用于NAFLD的管理，如二甲双胍、噻唑烷二酮类（TZD）、胰高血糖素样肽-1（GLP-1）类似物和二肽基肽酶-4（DPP4）抑制剂。减肥手术通常作为最后的手段，并且已显示出有希望的结果。术后通过饮食和运动进行生活方式干预对于维持体重减轻很重要。目前正在研究许多针对NAFLD的新型治疗方法，这些方法针对多种病理生理途径。本综述旨在阐明NAFLD与T2DM之间的复杂关系以及IR如何将这两种疾病联系起来。我们还试图提高临床医生对这种关系的认识，以及一种疾病的存在如何应提高对另一种疾病存在的高度怀疑指数。
