Diabetes can hide liver damage

A nationwide Indian screening study of people with type 2 diabetes found that roughly one in four had liver scarring severe enough to be called “clinically significant fibrosis,” and about one in 20 already showed changes consistent with early cirrhosis (severe, potentially life‑threatening scarring). (thelancet.com) The project, called the DiaFib‑Liver Study, enrolled just over 9,200 adults across 27 hospitals and diabetes clinics between January and July 2024 and was led by Dr Ashish Kumar under the Diabetes and Liver Interest Group of Diabetes India; the investigators deliberately drew participants from routine diabetes care (not liver clinics) to avoid referral bias. (thehindubusinessline.com )(sciencedirect.com) The condition driving the scarring is described as metabolic dysfunction‑associated steatotic liver disease (MASLD), which is the updated name for what used to be called fatty liver disease and occurs when metabolic problems (for example insulin resistance) cause fat to build up in the liver. (medicaldialogues.in) “Fibrosis” in this context means scar tissue replacing healthy liver cells; unlike early fat accumulation, fibrosis reduces the organ’s ability to work and usually produces few or no symptoms until it is advanced. (thelancet.com) To detect fibrosis the study used non‑invasive liver stiffness testing (vibration‑controlled transient elastography, commonly known by the brand name FibroScan), which measures how “hard” the liver is as a proxy for scarring, and the field also commonly uses the FIB‑4 blood score (a calculation based on age and routine blood tests) as a first‑line screen before imaging. (mskcc.org)(echosens.com) The authors report that fibrosis — not simple fat in the liver — should be the focus of routine assessment in diabetes care and call for integrating non‑invasive fibrosis screening into diabetes clinics; the study also applied quality controls and excluded hepatology referrals to strengthen its claim that advanced liver disease is common in everyday diabetes populations. (thelancet.com)(sciencedirect.com) Existing evidence shows that FIB‑4 alone can miss some people with high liver stiffness, which is why guideline groups and recent screening algorithms recommend a two‑step pathway (FIB‑4 first, then elastography if the score is elevated) to identify patients who need hepatology referral. (www.cghjournal.org)(diabetesjournals.org)