New research from Sweden’s Karolinska Institutet highlights the possibility of screening people with type 2 diabetes for liver damage at the same time they are being screened for eye diseases. The study is published in Lancet Gastroenterology and Hepatology.
More than half of people with type 2 diabetes have steatotic (or fatty) liver disease, but most don’t realize it, since liver disease rarely causes symptoms in the early stages. Over time, liver fibrosis can develop. This is a type of liver scarring that can lead to cirrhosis or liver cancer in some patients. International guidelines recommend screening for liver fibrosis in people at higher risk for it, including patients with type 2 diabetes.
“Unfortunately, severe liver diseases are often detected late when the prognosis is poor,” says Hannes Hagström, associate professor at the Department of Medicine at the Karolinska Institutet in Huddinge and consultant in hepatology at the Karolinska University Hospital. “Given that there is now an approved treatment for steatotic liver disease with fibrosis, it would be good to be able to screen diabetic patients for liver fibrosis and thus prevent serious disease.”
In Sweden, retinal scanning (fundus photography) is an established screening program to detect eye damage in people with type 2 diabetes. In a new study, Hannes Hagström and his fellow researchers investigated whether it would be possible to simultaneously detect fibrosis liver by elastography. This ultrasound-based technique is painless and takes 5 to 10 minutes to perform.
“This would allow us to kill two birds with one stone and easily detect liver fibrosis in this group of patients before it develops into cirrhosis or liver cancer,” says Hannes Hagström. “Our study shows that many patients with type 2 diabetes are willing to undergo this type of combined testing.”
Researchers asked more than 1,300 patients with type 2 diabetes who underwent retinal scanning if they would also consider having their liver examined using elastography. More than 1,000 people, 77 percent of the study participants, said yes.
15.8 percent of patients who had their liver examined by elastography had findings suggestive of liver fibrosis, while 5.0 percent had findings suggestive of advanced liver fibrosis or cirrhosis. However, upon further examination and re-evaluation, these figures were lower; 7.4 percent and 2.9 percent respectively.
“This shows that the method gives many false positives, partly because many people probably did not fast as instructed in the first test,” says Hannes Hagström. “The next step will be to perform health economic analyzes to see if the combined strategy of screening for eye and liver diseases is beneficial,” he concludes.
The study was carried out in collaboration with the Capio Ögon Stockholm Globen eye clinic. It was mainly funded by the pharmaceutical companies Gilead Sciences and Pfizer, and the Stockholm Region.
Hannes Hagström’s research group has received research funding from Astra Zeneca, EchoSens, Gilead, Intercept, MSD, Novo Nordisk and Pfizer. He has also consulted or served on advisory boards for Astra Zeneca, Bristol Myers-Squibb, MSD and Novo Nordisk, and has served on review committees for Arrowhead, Boehringer Ingelheim, KOWA and GW Pharma.