Implementation of a liver health check in people with type 2 diabetes.

As morbidity and mortality related to potentially preventable liver diseases are on the rise globally, early detection of liver fibrosis offers a window of opportunity to prevent disease progression. Early detection of non-alcoholic fatty liver disease allows for initiation and reinforcement of guidance on bodyweight management, risk stratification for advanced liver fibrosis, and treatment optimisation of diabetes and other metabolic complications. Identification of alcohol-related liver disease provides the opportunity to support patients with detoxification and abstinence programmes. In all patient groups, identification of cirrhosis ensures that patients are enrolled in surveillance programmes for hepatocellular carcinoma and portal hypertension. When considering early detection strategies, success can be achieved from applying ad-hoc screening for liver fibrosis in established frameworks of care. Patients with type 2 diabetes are an important group to consider case findings of advanced liver fibrosis and cirrhosis, as up to 19% have advanced fibrosis (which is ten times higher than the general population) and almost 70% have non-alcoholic fatty liver disease. Additionally, patients with type 2 diabetes with alcohol use disorders have the highest proportion of liver-related morbidity of people with type 2 diabetes generally. Patients with type 2 diabetes receive an annual diabetes review as part of their routine clinical care, in which the health of many organs are considered. Yet, liver health is seldom included in this review. This Viewpoint argues that augmenting the existing risk stratification strategy with an additional liver health check provides the opportunity to detect advanced liver fibrosis, thereby opening a window for early interventions to prevent end-stage liver disease and its complications, including hepatocellular carcinoma.
Competing Interests: Conflict of interests LV reports consulting fees from Gilead, Pfizer, Astra Zeneca, Novo Nordisk, Intercept Pharmaceuticals, Diatech Pharmacogenetics, IONIS, and Boehringer Ingelheim; grant support from Gilead; and speaker fees from MSD, Gilead, AlfaSigma, AbbVie, and Viatris. JFD reports consulting fees from Intelligent Ultrasound and speaker fees for Gilead and GE systems. AMA reports consulting fees from NovoNordisk and grant support from Target, Novo Nordisk, and Pfizer. MN reports consulting fees from Altimmune, Cytodyn, 89bio, GlaxoSmithKline, Madrigal, Merck, Novo Nordisk, Northsea Therapeutics, Perspectum, Terns, and Takeda; grant support from Allergan, Akero, Bristol Myers Squibb, Gilead, Galectin, Genfit, GlaxoSmithKline, Conatus, Corcept, Enanta, Madrigal, Novartis, Novo Nordisk, Shire, Takeda, Terns, Viking, and Zydus; and stock options with Rivus Pharma, CIMA, Cytodyn, and ChronWell. MER reports consulting fees from Intercept Pharmaceuticals, Gilead Sciences, Genfit, NGM Biopharmaceuticals, Enanta, Immuron, Fractyl, Prociento, Gelesis, Merck, Bristol Myers Squibb, Metacrine, Viking Therapeutics, Allergan, Cymabay, Boehringer Ingelheim, Genentech, 89bio, Galecto, Terns, Sagimet, Thetis, Fractyl, Lipicine, GSK, Coherus, and Novartis. FT reports consulting fees for Allergan, AstraZeneca, Bayer, Gilead, Bristol Myers Squibb, Boehringer, Intercept, Ionis, Inventiva, Merz, Pfizer, Alnylam, NGM Biopharma, CSL Behring, Madrigal, Novo Nordisk, and Novartis; grant support from Allergan, Bristol Myers Squibb, Inventiva, and Gilead (funding to institution); speaker fees from Gilead, AbbVie, Falk, Merz, Intercept, Sanofi, and AstraZeneca; expert testimony for Alnylam; participation on a data safety monitoring board for Pfizer; and travel support from Gilead. SF reports consulting fees from AbbVie, Actelion, Aelin Therapeutics, Aligos Therapeutics, Allergan, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Meyers Squibb, CSL Behring, Coherus, Echosens, Eisai, Enyo, Galapagos, Galmed, Genentech, Genfit, Gilead Sciences, Intercept, Inventiva, Janssens Pharmaceutica, Julius Clinical, Madrigal, Medimmune, Merck Sharp & Dohme, NGM Bio, Novartis, Novo Nordisk, Promethera, and Roche; research grants from Astellas, Falk Pharma, Genfit, Gilead Sciences, GlympsBio, Janssens Pharmaceutica, Inventiva, Merck Sharp & Dohme, Pfizer, and Roche; and speaker fees from AbbVie, Allergan, Bayer, Eisai, Genfit, Gilead Sciences, Janssens Cilag, Intercept, Inventiva, Merck Sharp & Dohme, Novo Nordisk, and Promethera. MT reports speaker fees from Echosens and Siemens Healthcare. PNN reports consulting fees from Boehringer Ingelheim, Intercept, Madrigal, Bristol Myers Squibb, AstraZeneca, Gilead, Pfizer, GlaxoSmithKline, Novo Nordisk, Poxel Pharamceuticals, and Sun Pharma and grant support from Novo Nordisk. ING reports grant support from Gilead. JMS reports consulting fees from Apollo Endosurgery, Albireo Pharma, Bayer, Boehringer Ingelheim, Gilead Sciences, GlaxoSmithKline, Intercept Pharmaceuticals, Ipsen, Inventiva Pharma, Madrigal, MSD, Northsea Therapeutics, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, and Siemens Healthineers; grant support from Gilead Sciences, Boehringer Ingelheim, and Siemens Healthcare; and speaker fees from Boehringer Ingelheim, Echosens, MedPublico, Novo Nordisk, and Madrigal Pharmaceuticals. AB reports consulting fees from Inventiva and grant support from Boehringer Ingelheim. AGH reports consulting fees from Inventiva, Echosens, Novo Nordisk, Gilead, and Julius Clinical. CC reports consulting fees from Novo Nordisk, Gilead, AstraZeneca, Bayer, E-Scopics, Intercept, and Lilly; research support from Echosens, E-scopics, and Gilead; and speaker fees from Madrigal, AstraZeneca, Gilead, Novo Nordisk, Lilly, and LVL. KC reports consulting fees from Altimmune, Arrowhead, AstraZeneca, Boehringer Ingelheim, Covance, 89bio, Bristol Myers Squibb, Lilly, Madrigal, Merck, Myovant, Novo Nordisk, Prosciento, Quest, Sagimet, Sonic Incytes, and Terns and grant support from Echosens, Inventiva, Novo Nordisk, Nordic Bioscience, Poxel, Labcorp, and Zydus. MR reports consulting fees from Boehringer, Pfizer, Novo Nordisk, and Eli Lilly and grant support from Boehringer, Novo Nordisk, Nutricia Danone, and Sanofi. HH reports consulting fees from AstraZeneca and grant support from AstraZeneca, EchoSens, Gilead, Intercept, MSD, and Pfizer. VW-SW reports consulting fees from AbbVie, Boehringer Ingelheim, Echosens, Gilead Sciences, Intercept, Inventiva, Novo Nordisk, Pfizer, Sagimet Biosciences, TARGET PharmaSolutions, and Visirna; speaker fees from AbbVie, Gilead Sciences, Novo Nordisk, and Unilab; travel support from AbbVie and Gilead Sciences; grant support from Gilead Sciences; and stock options for Illuminatio Medical Technology. LC reports consulting fees from Echosens, Madrigal, MSD, Novo Nordisk, Pfizer, Sagimet, and Siemens Healthineers and speaker fees from Echosens, Inventiva, and Novo Nordisk. JVL reports grants and speaker fees from AbbVie, Gilead Sciences, MSD, and Roche Diagnostics and speaker fees from Intercept, Jannsen, Novo Nordisk, and ViiV, outside of the submitted work. EAT reports consulting fees from Alexion, Novo Nordisk, Pfizer, Boehringer, Orphalan, and Univar and speaker fees from Novo Nordisk, Orphalan, and Dr Falk. All other authors report no competing interests.
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