Endocrine Abstracts

Introduction: Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are common conditions that regularly coexist and can act synergistically to drive adverse outcomes. The prevalence of NAFLD in T2DM is 70%, with 16% having evidence of advanced hepatic fibrosis.

Aims: Our study therefore had two aims: Firstly, to define the attitudes and current clinical practice of diabetes specialists towards NAFLD across the UK and secondly, to implement an evidenced-based pathway for the assessment of NAFLD in patients attending diabetes outpatient clinics.

Materials and methods: An online survey was disseminated to diabetologists across the UK. Based on findings from this survey, all diabetic patients attending outpatient clinics at Oxford University Hospitals were screened for advanced fibrosis using a Fib-4 score. Those with elevated scores may then benefit from referral to the multidisciplinary metabolic hepatology clinic with combined hepatology and diabetes input.

Results: One hundred and sixteen diabetes specialists responded to the survey. Only 4.5% of responders correctly judged the prevalence of NAFLD in diabetic patients to be >50%. Even fewer (1.5%) correctly judged the prevalence of advanced fibrotic disease to be >15%. Whilst most diabetologists performed liver function tests, the majority (68%) had not used any non-invasive scoring system to assess risk of advanced disease. In light of these findings, a local ‘think NAFLD’ campaign was launched to educate diabetologists on the risk and assessment of NAFLD. In the subsequent 6 months 460 patients attending diabetic clinics were screened for advanced fibrosis using Fib-4. 16.5% of those screened had an elevated Fib-4.

Conclusions: Amongst diabetologists, there remains limited awareness of the prevalence and severity of NAFLD in the patients they treat. Fib-4 score can easily be used in clinical practice to identify patients at risk of advanced fibrosis who may then benefit from a dedicated multidisciplinary approach to their management.