Research Summary

Guideline Update from the American Diabetes Association for the Detection, Management of Patients With Diabetes, Nonalcoholic Fatty Liver Disease

The American Diabetes Association (ADA) has published updates in the Standards of Care in Diabetes—2023 that include recommendations for the detection and management of nonalcoholic fatty liver disease (NAFLD) in people with diabetes.1

Up to 70% of people with type 2 diabetes are affected by liver disease, and NAFLD—including nonalcoholic steatohepatitis (NASH)—is the most common form of liver disease in people with diabetes.1 NAFLD poses risks for the development of cirrhosis and liver cancer and is associated with an increased risk of cardiovascular disease and death.

In the ADA’s update, the authors emphasize the importance of detecting NAFLD early, particularly in patients with diabetes, as it allows for timely treatment and the reduction in developing serious complications.

“Diabetes and liver disease are closely linked, and it is essential that healthcare professionals have the most current information to effectively detect and manage the disease,” Nuha ElSayed, MD, MMSc, the overseer of the ADA standards of care guidelines and chair of the professional practice committee, said in the press release.

The new recommendations by the ADA address2:

  • Lifestyle changes in patients with NAFLD and type 2 diabetes with overweight or obesity
  • The use of a glucagon-like peptide 1 (GLP-1) receptor agonist for adults with type 2 diabetes and overweight or obesity who are diagnosed with NAFLD
  • The use of glucose-lowering therapies other than pioglitazone—another preferred agonist—or GLP-1
  • Insulin therapy as the preferred treatment of hyperglycemia in adults with type 2 diabetes and decompensated cirrhosis
  • Managing cardiovascular risk in patients
  • Statin therapy use in adults with type 2 diabetes and compensated cirrhosis from NAFLD
  • Metabolic surgery is an appropriate option to treat NASH in adults with type 2 diabetes, but should be used with caution in adults with type 2 diabetes with compensated cirrhosis from NAFLD

The updated guidelines are based on recent scientific research and clinical trials and reflect the current clinical knowledge in NAFLD.



  1. American diabetes association releases a guideline update in NAFLD (non-alcoholic fatty liver disease) and diabetes. News release. American Diabetes Association; June 25, 2023. Accessed June 27, 2023.
  2. ElSayed NA, Aleppo G, Aroda VR, et al. Addendum. 3. Prevention or delay of type 2 diabetes and associated comorbidities. Diabetes Care. 2023;46(Suppl. 1):S49-S67. doi:10.2337/dc23-ad09