| Abstract: |
Type 2 diabetes is associated with a large number of liver disorders including elevated liver enzymes, fatty liver disease, cirrhosis, hepatocellular carcinoma, and acute liver failure. In addition, there is an unexplained association with HCV. The SMR for cirrhosis is higher than that for CVD in type 2 diabetes.Type 2 diabetic patients more frequently had elevated ALT (22.9 vs. 5.3%) and gamma-glutamyl transferase (GGT) (23.7 vs. 10.5%) levels than those with type 1 diabetes. However, increases in LFTs were rarely more than twice the ULN. Although abnormal LFT results are common in diabetes, especially in overweight type 2 diabetic patients, they are not reliable in predicting histological changes in the liver.The prevalence of NAFLD in diabetes is estimated at 34–74% and, in diabetes with obesity, at virtually 100%, while once considered a benign process, NASH has been found to lead to cirrhosis and, in some cases, to HCC. Of patients with NAFLD, 50% have NASH and 19% have cirrhosis at the time of diagnosis.Obesity, hypertriglyceridemia, hyperglycemia, and type 2 DM, are the best known risk factors for NAFLD. The strongest association of NASH is with central obesity (visceral adiposity), not overall obesity. A subset of factors has been linked to NAFLD severity; the most powerful are hyperglycemia, type 2 DM evidence of metabolic syndrome (e.g., arterial hypertension), obesity, and age.
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