Low awareness of non-alcoholic fatty liver disease in patients with type 2 diabetes in Swedish Primary Health Care

Abstract

Objectives

Non-alcoholic fatty liver disease (NAFLD) is more common in patients with type 2 diabetes mellitus (T2DM) compared to individuals without. Recent guidelines recommend screening for NAFLD in patients with T2DM. Our aim was to investigate the prevalence of NAFLD in patients with T2DM in a Swedish primary health care setting, how they are cared for and assess the risk of biochemical signs of advanced fibrosis.

Material and methods

In this cohort study, patients with T2DM from five primary health care centers were included. Medical records were retrospectively reviewed and living habits, medical history, results of diagnostic imaging and anthropometric and biochemical features were noted in a standardized form. The risk of steatosis and advanced fibrosis was assessed using commonly used algorithms (FLI, HSI, NAFLD-LFS, NAFLD ridge score, FIB-4 and NFS).

Results

In total 350 patients were included. Diagnostic imaging had been performed in 132 patients and of these, 34 (26%) had steatosis, which was not noted in the medical records in 16 (47%) patients. One patient with steatosis had been referred to a hepatologist. Of assessable patients, 71–97% had a high to intermediate risk of steatosis and 29–65% had an intermediate to high risk of advanced fibrosis according to the algorithms used.

Conclusion

This study indicates a high prevalence of NAFLD among T2DM patients in Swedish primary care. Patients with known NAFLD were followed up to a very low extent. Using fibrosis algorithms in primary health care would result in many patients needing further assessment in secondary care.

Keywords:

• NAFLD
• diabetes mellitus type 2
• primary health care
• epidemiology
• population
• risk

Acknowledgments

The authors thank Ajla Aleckovic, Alexander Zorbas and Axel Lihagen for their help with the data collection.

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by ALF Grants (Region Östergötland, Medical Research Council of Southeast Sweden).