People with type 2 diabetes should receive regular monitoring of liver function, as they could be at risk of developing life-threatening cirrhosis and liver cancer. Share on Pinterest Type 2 diabetes may be an independent risk factor for some severe liver conditions. This was one of the conclusions of a very large study of 82 million adults living in Europe. Another finding was that for many people who develop cirrhosis and liver cancer, it seems that the conditions are already at an advanced stage at the time of diagnosis. Researchers from Queen Mary University of London and the University of Glasgow, both in the United Kingdom, led the study. They report their results in a paper that now appears in the journal BMC Medicine. The purpose of the investigation was to estimate the risk of cirrhosis and liver cancer in people with nonalcoholic fatty liver disease (NAFLD) or steatohepatitis (NASH). NAFLD is a major cause of liver disease worldwide. Its global prevalence has risen from 15% to 25% in the decade leading up to 2010 and parallels the rising tide of obesity and type 2 diabetes. For many people with NAFLD, the condition does little harm. However, some with NAFLD will go on to develop the much more aggressive form, NASH, which damages the liver and can lead to cancer.

Need for earlier diagnosis of NAFLD Because people who have NAFLD or NASH are at risk of the conditions becoming life-threatening, diagnoses need to be early; that way, doctors can offer effective treatment promptly. However, senior study author Dr. William Alazawi, a reader and consultant in hepatology at Queen Mary University of London, suggests that doctors may not be picking up NAFLD early enough. He and his team were surprised to find much lower rates of diagnosed NAFLD than they expected among the 82 million electronic health records that they analyzed. This means that “many patients are actually undiagnosed in primary care,” says Dr. Alazawi. “Even over the short time frame of the study, some [people] progressed to more advanced, life-threatening stages of disease, suggesting that they are being diagnosed very late,” he adds. According to the American Liver Foundation, NAFLD affects around 100 million people in the United States. It is normal for some fat to be present in the liver. However, when more than 5–10% of the organ’s weight is fat, a state called fatty liver (steatosis) develops. NAFLD is fatty liver that is not related to alcohol consumption. NASH is a more severe form of NAFLD that swells and damages the liver and can lead to cirrhosis, liver failure, and, in some cases, cancer. Around 1 in 6 of those with NAFLD will develop NASH, which most often develops when a person is 40–60 years old and affects women more than men. It is frequently the case that people with NASH live with the condition for years before they discover that they have it.