The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide is a new podcast series for healthcare professionals who treat diabetic patients, the patients themselves and their caregivers. Episode 1 introduces some of the research that has led AACE to issue guidelines, AGA to propose clinical care pathways and AHA to produce a white paper on the links between Fatty Liver Disease and CVD Risk.
Did you know?
- 15% of diabetic patients might have fibrosis.
- In one study, 70% diabetics had fatty liver and 35% had NASH?
- 25% of deaths in people with NAFLD are cardiovascular disease?
- NAFLD is an independent risk factor for development of diabetes, cardiovascular disease, and chronic kidney disease.
NAFLD-Diabetes Dual Prevalence
First, hepatology researcher and key opinion leader Dr. Stephen Harrison reviews the results of his 2021 paper, Prospective Evaluation of the Prevalence of Non-Alcoholic Fatty Liver Disease and Steatohepatitis in a Large Middle-Aged US Cohort. This paper asked over 800n seemingly healthy people with no reported liver issues who were receiving a colonoscopy if they would like to have their livers evaluated at the same time. In this apparently healthy population, 37% tested positive for NAFLD and 14% tested positive for biopsy-confirmed NASH. Among Type 2 diabetics, the corresponding numbers were 70% with NAFLD and 35% with NASH. All these numbers are higher than previously reported estimates derived retrospectively from secondary databases.
Next, endocrinology researcher and key opinion leader Ken Cusi discusses s his work looking at NAFLD and NASH in diabetic patient populations. He discusses studies confirming that patients with diabetes are at least twice as likely to have NAFLD or NASH as non-diabetics. He notes that this effect is confirmed in overweight as well as obese patients and is proven independent of obesity (NOTE: the two together are worse than either alone). In practical terms, he notes that primary care and endocrinology clinics are the places we can identify NAFLD and early NASH before these become later-stage fibrosis or cirrhosis requiring attention from hepatologists. In that context, he notes that twice as many patients in an endocrinology clinic will test positive for NAFLD or NASH compared to a primary care clinic, thus making endocrinologists a vital target group for earlier identification and treatment of Fatty Liver Disease. In his practice, Ken advocates for every patient to receive a FIB-4 test, which can be found in most EMR systems and is an inexpensive, reasonably reliable negative predictor for F3 or F4 status.
Next, hepatology researcher and key opinion leader Kathleen Corey discusses some of her research on the link between CVD and NAFLD. Two key conclusions: over a relatively short period after initial induction into the study (median of 25.5 months), the presence of NAFLD causes a 70% increase in relative risk (4.1% vs. 2.6%) of a Major Adverse Cardiovascular Event (MACE). She agrees with Ken’s suggestion about FIB-4. She also notes the trend of primary care physicians to discontinue statins if the patient’s ALT level starts to rise and cautions that this step is likely to increase patient risk.
Finally, Kay Pepin, Director of Research Translation for Resoundant Inc. under joint appointment with the Mayo Clinic, discusses research demonstrating that a relatively simple MRE session can provide the information necessary to determine the likelihood that fibrosis will advance to cirrhosis or compensated cirrhosis will advance to decompensated states. She also notes that with insurance coverage, this is not an expensive test for many people. By adding a simple MRI module to the MRE session, physicians can derive a significant amount of additional information.
This podcast series and all the episodes are produced under a non-restricted grant from Novo Nordisk. Novo Nordisk has neither influenced nor reviewed the contents of this podcast in any way. This content represents the views of the speakers and does not necessarily represent the views of Novo Nordisk. The content herein is for educational purposes only and should not be taken as medical advice.