Several studies in general population have found a prevalence of 3 to 8% of advanced liver fibrosis in the context of NAFLD by means of noninvasive procedures. Diabetes prevalence has been increasing worldwide. It is one of the main risk factors for chronic liver disease and cirrhosis. Liver fibrosis is a strong predictor of mortality. In pragmatic terms do you think that all diabetic patients seen in consultation should be screened for liver fibrosis? If you agree which would be your strategy of study?
Yes. I think it is easy to perform at least a liver san for evaluation of the degree of fibrosis in most of diabetics that you can
Thanks Dr Rodrigo for your reply
Would you include in screening patients with DM, with normal hepatic enzymes, without clinical signs of chronic liver disease, without other components of metabolic syndrome, particularly obesity and dyslipidemia. This type of diabetic patient is not rare. Although there are not specific studies, he/she represents around 30 to 40% of all diabetic patients (depending of course of genetic and environmental and geographic background). Do you think that elastography (Fibroscan) or serologic fibrosis score should be used first? Thank you for your comments
I think obese diabetics (type 2) should do liver enzymes and elastography. Type 1 diabetics, initially only the enzymes and in the second step, if they are elevated they would do elastography
Thanks to all
What would be the justification for doing screening with elastography every day to all diabetic patients? Is this strategy cost- benefit positive?
In the current EASL-EADO guidelines, for T2DM, you need to check and screen for presence of NAFLD, irrespective of liver enzyme levels, due to high risk of disease progression include liver fibrosis. The guidelines also recommend, in individuals with NAFLD, screening for diabetes is mandatory, by fasting or random blood glucose or HbA1c. It is also recommended that once you confirm presence of NAFLD, screening of the cardiovascular system is mandatory because CV complications frequently dictate the outcome.
A very pertinent question in the present world scenario. I feel first all diabetics should be screened for presence of NAFL [by USG]. In those who have it, further decision to screen for fibrosis should depend on higher age, presence of obesity and the metabolic syndrome, other predisposing factors for liver disease, presence of other comorbidities especially cardiovascular disease.
Dear Ronald for your information. What do you think about screening for liver fibrosis in diabetic patients and what is the procedure you use first?
Dear Diego,
For diabetic patients, when I screen them for liver fibrosis, i prefer using serum biomarkers and imaging (VCTE). Use of serum biomarkers like LIVERFASt test can provide assessment and staging of liver fibrosis even for early stages (F1-F2) compared to imaging tools like VCTE which is dependent on liver stiffness measurements and are good in detecting late stages of fibrosis (F3-F4). For clinicians, it is best that you have a diagnostic tool that is able capture the full spectrum liver fibrosis in any stage, especially in the early stages. If there is a discordance with LF and VCTE, which is rare, then I use SWE or MRE. In my experience, most of the serum biomarker test results is correct.
I think: Firstly, serum biomarkers and for definitiv diagnosis, fibroelastography.
You can use fib-4 in patients with steatosis to stratisfy risk and decide wether to go to swe/fibroscan
Dear Lukas
It is a pragmatic and easy to do algorithm. Thanks your your information.
May you give the reference?
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