Preview: Diabetes and Liver Disease: Exploring the Intersections and Best Practices
In this video, Carol Wysham, MD, provides a preview of the session "Diabetes and Liver Disease: Exploring the Intersections and Best Practices," at our Practical Updates in Primary Care 2023 Virtual Series, including how people with non-alcoholic fatty liver disease and diabetes present, screening tests, and how to utilize lifestyle changes and bariatric surgery in the management of patients with comorbid fatty liver disease and diabetes, and more.
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Carol Wysham, MD, is a clinical professor of medicine at the University of Washington School of Medicine and a clinical endocrinologist at MultiCare Rockwood Clinic (Spokane, WA).
Dr Carol Wysham: Hello, I'm Dr Carol Wysham. I'm a clinical professor of medicine at the University of Washington in Spokane, Washington, and a clinical endocrinologist for most of my day.
In our session, we have three excellent speakers. We have a gastroenterologist, a primary care physician's assistant, and myself discussing the topic of non-alcoholic fatty liver disease in primary care.
So you have probably heard a lot about non-alcoholic fatty liver disease and recognize that it has now become the most common form of liver disease worldwide. The worldwide prevalence is somewhere around 32%. In patients with diabetes, it could be as much as double, but certainly at least 50% of our patients with type two diabetes have fatty liver disease.
Non-alcoholic fatty liver disease exists in a spectrum, starting with benign fatty infiltration of the liver, progressing through several stages of fibrosis onto cirrhosis, and also is a leading risk for hepatocellular carcinoma.
So our goal is to identify our patients before they reach advanced fibrosis, or certainly before they reach cirrhosis, so that our therapies, whether it be lifestyle or medications, have a greater chance of preventing the progression of this disease. But it's also important to realize that we need to be screening for hepatocellular carcinoma in those patients, particularly those that have developed any degree of fibrosis.
Now, of these patients that have diabetes or pre-diabetes, 90 to 95% of them are being cared for by primary care. So there are at least 30 million people in the United States that have type two diabetes and another 60 to 80 million people who have pre-diabetes. And it is this population in which we need to think about the possibility of non-alcoholic fatty liver disease and to do the appropriate screening.
So we will be talking about, in this session, how the patients with non-alcoholic fatty liver disease and diabetes present. We'll be talking about any potential screening tests that should be done. And then we will also talk about how to use lifestyle, weight loss, exercise, and bariatric surgery in the management of the patients who have comorbid fatty liver disease and diabetes. And then we'll also discuss the importance of selection of antihyperglycemic therapies for the patient with diabetes and non-alcoholic fatty liver disease. Again, in hopes of decreasing the amount of fat and inflammation that might be going on in the liver.