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Increasing fatty liver detection rates

Tuesday 02 February 2021

A new research project funded by the PA Research Foundation aims to increase detection rates of non-alcoholic fatty liver disease among people with type 2 diabetes.

Led by hepatologist and University of Queensland researcher Professor Elizabeth Powell, the project entitled Diabetes and non-alcoholic fatty liver disease: implementing the right care, in the right place, at the right time, may also impact the way diabetes is managed going forward.

Professor Elizabeth Powell

The study which received a 2021 PA Research Foundation research award will see researchers work closely with GPs and diabetes specialists to implement a practical pathway to optimise care of non-alcoholic fatty liver disease in high risk patients with Type 2 diabetes.

Highlighting the need for the research is the fact that around 30 per cent of the population have fatty liver, but in people with diabetes that prevalence jumps to between 60 and 70 per cent.

"In the majority of affected individuals, fatty liver is stable or slowly progressive and doesn't lead to clinically significant liver disease. Unfortunately, in the presence of diabetes, fatty liver has a higher risk of developing progressive scarring or fibrosis. And if that happens, these people may be at risk of developing cirrhosis and related complications including liver cancer," Prof Powell said.

"This is an opportunity for people with diabetes in the community to be screened for the presence of fatty liver. And then to have an assessment to determine whether that fatty liver is leading to any liver related problems like scarring.

"That's important because if severe scarring is identified, we would recommend that these people are referred to a hepatology clinic for further assessment of cirrhosis and complications.

"If cirrhosis is present, surveillance for liver cancer is important, as this is something that's increasing in Australia and globally, often in the setting of fatty liver."

The research will see diabetes patients undergo a FibroScan® test for fatty liver at their regular diabetes clinic appointment, giving them the opportunity to be screened for a fatty liver so that their risk of liver scarring can be assessed, and the right care and treatment plan put in place.


A patient undergoing a FibroScan® test

Low risk patients can be managed with dietary modification and increased physical activity, while patients at high risk for severe liver scarring will be referred to a hepatology clinic, likely at the PA Hospital, where they can be enrolled in a surveillance program for liver cancer and other cirrhosis related complications like oesophageal varices (enlarged veins in the lower oesophagus).

Professor Powell said one of the expected benefits of the study will be increased education and collaboration between doctors, specialists, and patients.

"Fatty liver can often "slip below the radar", unfortunately. A person with fatty liver may not have any symptoms and liver scarring can progress silently until they develop cirrhosis complications. Even routine blood tests may not be very informative," she said.

This is a collaborative study with primary care clinicians, the diabetes specialists from the PA Hospital and Associate Professor Tony Russell.

"The Director of Endocrinology and Diabetes, A/Prof. Tony Russell has invited us to work alongside clinicians in his diabetes clinics in the community, to offer this study opportunity to his patients.

"This is a really exciting opportunity for liver specialists to work side-by-side with diabetes specialists and GPs in the community to offer screening for fatty liver to people with diabetes. "This is going to be an opportunity to educate patients and doctors looking after people with diabetes.

"If the study is successful, this may lead to a change in the way diabetes is managed in the future. We predict that in the future, all patients with diabetes may also be assessed for fatty liver. That's one of the reasons why this study is so important, because it may make changes to the way we practice moving forward."

Costs to the community and the individual could be reduced significantly as a result of the project, as Prof Powell said at present, many patients with fatty liver referred to liver clinics are in a low-risk category, meaning they could be managed in the community by their GP or diabetes specialist.

"Many patients prefer being managed in the community by a GP who they're familiar with and it's much more convenient for them. GPs have a very important role in a holistic approach to management of fatty liver, helping to minimize cardiometabolic risk and addressing lifestyle issues, good nutrition and increased physical activity," she said.

"Managing patients with a low risk of liver disease in the community may be better for the patient, and may also be beneficial for the specialist outpatient clinics at the hospital, because it makes space available in the clinic for high-risk patients who have a much greater concern for liver-related complications and may be better managed in a tertiary centre."

Prof Powell said she is very thankful for the support of her research, work made possible by the Foundation's supporters.

"We're incredibly grateful to the donors who've provided funds for this study and we would love to have the opportunity to give them some feedback and show them how this important work is improving the health of people with type 2 diabetes," she said.

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