Concern over 'silent epidemic' of liver disease

Particular risk to people with type 2 diabetes
  • Deborah Condon

Ireland is experiencing a ‘silent epidemic' of liver disease and people with type 2 diabetes are particularly at risk, experts have warned.

Non-alcoholic fatty liver disease (NAFLD) is different to liver disease that is caused by excessive alcohol intake. It is common in people with type 2 diabetes, high BMIs and among those who consume a high fat, high sugar diet.

If left untreated, it can lead to cirrhosis, a serious complication resulting in the loss of liver cells and irreversible scarring.

A recent liver screening initiative revealed that 21% of people with type 2 diabetes already had advanced fibrosis (scarring) or cirrhosis, while 27% had fibrosis without cirrhosis.

The Diabetes Liver Screen Initiative, the first of its kind in Ireland, was undertaken to raise awareness of the importance of liver health among people with type 2 diabetes.

It was carried out last November by consultant hepatologist, Prof Suzanne Norris, in collaboration with the national charity, Diabetes Ireland. Members of the charity were scanned using the innovative FibroScan test - a 10-minute non-invasive, pain-free scan.

Each participant received their result on the day of their scan and a consultant report, with recommendations where necessary, was sent to each person and their GP/consultant, so that appropriate treatment could commence immediately.

Of the 21% who already had advanced fibrosis or cirrhosis of the liver, the vast majority were non-drinkers or drank very little alcohol each week.

According to Prof Norris, this initiative ‘has been life-changing for many of those screened'.

"For those one in five patients with advanced fibrosis/cirrhosis, awareness means they can now take the necessary steps to prevent further liver damage and to prevent complications such as liver cancer," she explained.

She pointed out that NAFLD can be prevented or reversed as a result of healthy eating, exercise and maintaining a healthy weight. However for those affected, the disease often displays no symptoms and routine liver tests may not pick it up or be able to determine how bad it is.

In fact, of the 21% with advanced fibrosis or cirrhosis, most had produced ‘normal' results in liver function tests.

The FibroScan can identify patients at risk of NAFLD. In some cases, a liver biopsy may also be required.

According to Dr Anna Clarke, health promotion manager with Diabetes Ireland, NAFLD is not something that is routinely checked in type 2 diabetes patients with normal liver function blood results, ‘but it should be'.

"Diabetes Ireland was delighted to offer this service to our members. The startling results on this small cohort of people indicate the need to extend
this to become part of routine screening, similar to the eye (Retinascreen) and foot assessment that is an essential part of the annual (diabetes) review," she commented.

Prof Norris is speaking about this topic at the Diabetes Ireland DICE Conference in Croke Park on February 23. Following the screening initiative and review of clinical outcomes, she has concluded that in patients with type 2 diabetes, ‘the presence of NAFLD should be looked for irrespective of liver enzyme blood tests, since type 2 diabetes patients are at high risk of liver disease progression'.

For more information on Diabetes Ireland, click here

For more information on liver health and the FibroScan, click here


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