Implementation of a liver health check in people with type 2 diabetes

Kushala W. M. Abeysekera, Luca Valenti, Zobair Younossi, John F. Dillon, Alina M. Allen, Mazen Nourredin, Mary E. Rinella, Frank Tacke, Sven Francque, Pere Ginès, Maja Thiele, Philip N. Newsome, Indra Neil Guha, Mohammed Eslam, Jörn M. Schattenberg, Saleh A. Alqahtani, Marco Arrese, Annalisa Berzigotti, Adriaan G. Holleboom, Cyrielle CaussyKenneth Cusi, Michael Roden, Hannes Hagström, Vincent Wai-Sun Wong, Vincent Mallet, Laurent Castera, Jeffrey V. Lazarus, Emmanuel A. Tsochatzis (Lead / Corresponding author)

    Research output: Contribution to journalReview articlepeer-review

    11 Citations (Scopus)
    3 Downloads (Pure)


    As morbidity and mortality related to potentially preventable liver diseases are on the rise globally, early detection of liver fibrosis offers a window of opportunity to prevent disease progression. Early detection of non-alcoholic fatty liver disease allows for initiation and reinforcement of guidance on bodyweight management, risk stratification for advanced liver fibrosis, and treatment optimisation of diabetes and other metabolic complications. Identification of alcohol-related liver disease provides the opportunity to support patients with detoxification and abstinence programmes. In all patient groups, identification of cirrhosis ensures that patients are enrolled in surveillance programmes for hepatocellular carcinoma and portal hypertension. When considering early detection strategies, success can be achieved from applying ad-hoc screening for liver fibrosis in established frameworks of care. Patients with type 2 diabetes are an important group to consider case findings of advanced liver fibrosis and cirrhosis, as up to 19% have advanced fibrosis (which is ten times higher than the general population) and almost 70% have non-alcoholic fatty liver disease. Additionally, patients with type 2 diabetes with alcohol use disorders have the highest proportion of liver-related morbidity of people with type 2 diabetes generally. Patients with type 2 diabetes receive an annual diabetes review as part of their routine clinical care, in which the health of many organs are considered. Yet, liver health is seldom included in this review. This Viewpoint argues that augmenting the existing risk stratification strategy with an additional liver health check provides the opportunity to detect advanced liver fibrosis, thereby opening a window for early interventions to prevent end-stage liver disease and its complications, including hepatocellular carcinoma.

    Original languageEnglish
    Pages (from-to)83-91
    Number of pages9
    JournalLancet Gastroenterology and Hepatology
    Issue number1
    Early online date6 Dec 2023
    Publication statusPublished - 1 Jan 2024


    • alcohol-related liver disease
    • cirrhosis
    • elastography
    • ELF
    • fibrosis
    • FIB-4
    • hepatocellular carcinoma
    • NAFLD
    • obesity


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