Abstract
Several critical epidemiological facts underscore the urgent need to address non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes (T2D):
NAFLD is the most common liver disease in Canada, affecting approximately one in four Canadians;
NAFLD is projected to become the number one leading indication for liver transplant by 2025;
Individuals with T2D are at the greatest risk of liver disease progression in NAFLD; T2D is the main predictor of NAFLD-related liver fibrosis and mortality.
To put this into clinical perspective, consider the following fictitious case: A 45-year-old teetotaler, Caucasian woman with T2D and a body mass index (BMI) of 32 kg/m2, with no microvascular or macrovascular complications, was incidentally found to have “fatty liver” on abdominal ultrasound. ALT and AST were both within normal range. She was recommended to lose weight and control A1C. Twelve years later, she developed hematemesis and liver biopsy confirmed end-stage liver cirrhosis, with hepatocellular carcinoma. She was scheduled to undergo a liver transplant at age 59.
Despite the three established facts presented above and an abundance of cases similar to the one presented here, currently NAFLD is not being addressed during routine diabetes care as a complication of T2D.