In this episode of The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide, co-hosts Ken Cusi and Roger Green are joined by Jeff Lazarus and Jeff Budd to explore why clinical care pathways matter for fighting fatty liver.
Jeff Lazarus (referred to as ‘Laz’ for clarity) is the head of the Health Systems Research Group at ISGlobal and contributes as Associate Professor at the University of Barcelona where he is based. Jeff Budd is an Associate Professor within the division of general internal medicine at the University of Florida, providing primary care perspective for this session.
00:00 Introduction with Ken Cusi and Roger Green
15:55 Recognizing Fatty Liver Prevalence
24:28 Shifting Primary Care Perceptions and Utilizing FIB-4
31:54 Impact of Fatty Liver on Metabolic Health
46:41 Final Takeaway Notes from the Panelists
There are an estimated 100 million patients in the US with NAFLD and around 10,000 total hepatologists and gastroenterologists to treat. Laz elaborates on the idea that there are simply not enough human resources to rely on standalone fatty liver care services. From here, Ken picks up on the importance of identifying fatty liver patients in primary care settings. He reintroduces the frontline screening tool, FIB-4, which helps to estimate the amount of scarring in the liver through a simple calculation based on routine blood work results. The goal is to develop a reliable reflex in screening for fatty liver that has similarly been accomplished in kidney disease (albumin in urine) and diabetes (eye disease and neuropathy). An elevated FIB-4 is an urgent prompt for primary care to investigate cause and course of action.
Jeff describes when and why his own thinking around liver disease shifted. He emphasizes that NAFLD ought to be recognized on the frontlines as a “widely prevalent and progressive disease that can potentially be reversed if caught early.” Ken raises the challenge of optimizing pop-up metadata in electronic medical records. The idea is to prompt urgent and effective notifications to the primary care treaters without being too obstructive.
Roger steers the conversation to consider how fatty liver impacts a myriad of conditions pertinent to primary care services. For example, fatty liver increases risk for cardiovascular outcomes, complications of COVID, hepatocellular carcinoma and a swath of obesogenic cancers. Laz explains that in Hepatitis C, the aim is to catch it early to avoid extrahepatic manifestations. The group discusses the challenge of educating patients in a mere <13 minute consultation. Ken returns to his plea for providers to consider what is available today for treating diabetes and obesity using GLP-1s and pioglitazone. 46:41 As the session winds down, each panelist parts with a final takeaway message for the listeners. Tune in to learn more, and thank you for listening. If you enjoy the episode, have questions or interest around its contents, we kindly ask that you spread the word and help us put a major dent in fatty liver disease. We also encourage our audience to write us questions and look forward to integrating your on-ground perspectives in the discourse. This podcast series and all 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.