We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Severe asymptomatic non-alcoholic fatty liver disease in routine diabetes care; a multi-disciplinary team approach to diagnosis and management.
- Authors
Armstrong, Matthew J.; Hazlehurst, Jonathan M.; Parker, Richard; Koushiappi, Elena; Mann, Jake; Khan, Sheeba; Philips, Angela; Chandler, Liz; Johnson, Jill; Round, Maria; Haydon, Geoffrey; Karamat, Mohammad A.; Newsome, Philip N.; Tomlinson, Jeremy W.
- Abstract
Objectives: To prospectively use a non-invasive algorithm to identify asymptomatic, advanced non-alcoholic fatty liver disease (NAFLD) in a secondary care diabetes clinic and to determine the short-term effect of a multi-disciplinary team (MDT) approach in a liver clinic.Research design and methods: NAFLD Fibrosis Score (NFS) was calculated in 64 asymptomatic patients with type 2 diabetes. Advanced fibrosis was identified using transient elastography and confirmed with liver biopsy. In a subsequent retrospective study, 95 patients newly referred to the NAFLD MDT clinic were investigated and the impact of the MDT approach assessed.Results: 25/64 (39.0%) of patients with diabetes had a low NFS (<–1.455). 39/64 (61.0%) patients had a high or indeterminate NFS and were referred for review in the NAFLD MDT clinic, of which 23/39 attended for assessment. 19/23 (82.6%) were diagnosed with NAFLD, of which 6/19 (31.6%) patients had a positive transient elastography (&geq;8 kPa). Liver biopsy confirmed advanced fibrosis in 5/6 cases, with moderate fibrosis in 1 case.In the retrospective study, 65/95 (68.4%) new referrals to the NAFLD MDT clinic had a diagnosis of NAFLD. Over a median 98 days (IQR 70–182) follow-up, there was a significant improvement in weight (–0.8 kg; P = 0.024), total cholesterol (–0.2 mmol/L; P = 0.044), ALT (alanine transmaminase, −12.5 IU/L; P < 0.001) and GGT (gammu-glutamyl transferase, −13.0 IU/L; P < 0.0001). 7/28 (25%) of patients with diabetes achieved >5% weight loss.Conclusions: A significant proportion of asymptomatic patients attending type 2 diabetes clinics have undiagnosed advanced NAFLD fibrosis. An MDT approach to NAFLD results in short-term improvements in metabolic and liver parameters.
- Subjects
FATTY liver; ALGORITHMS; LIVER biopsy; BILIARY tract; DIABETIC acidosis; CARBOHYDRATE intolerance
- Publication
QJM: An International Journal of Medicine, 2014, Vol 107, Issue 1, p33
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hct198