WHY IS THE RISK OF LIVER FIBROSIS RISING AMONG PATIENTS WITH TYPE-2 DIABETES?

WHY IS THE RISK OF LIVER FIBROSIS RISING AMONG PATIENTS WITH TYPE-2 DIABETES?

20-APRIL-ENG 16

RAJIV NAYAN AGRAWAL

ARA----------------------------When an individual is diagnosed with Type 2 diabetes, doctors typically prescribe regular monitoring of three key parameters—blood sugar levels, kidney function, and eye health—to detect complications such as retinopathy in their early stages. Retinopathy is a condition in which elevated blood sugar levels damage the tiny blood vessels within the eyes. Beyond these three well-known complications of diabetes, a new study published this month in *The Lancet Regional Health–Southeast Asia* highlights a "fourth complication."

The 'DiFiab-Liver Study'—conducted across diabetes clinics throughout India and involving over 9,000 patients—now argues that screening for liver fibrosis (i.e., scarring of the liver) should also be incorporated into national health programs. If left unaddressed, this condition can progress into severe liver disease.

Researchers discovered that one in every four adults with Type 2 diabetes participating in the study exhibited significant liver scarring, while one in twenty was likely already suffering from cirrhosis—a condition characterized by severe liver damage. Most concerning of all is the fact that almost none of these patients were aware of this underlying issue.

The liver is the body's largest internal organ. When subjected to repeated damage—whether from excessive fat accumulation, high blood sugar levels, or alcohol consumption—it attempts to repair itself by generating scar tissue. Over time, this scar tissue accumulates, eventually progressing into fibrosis.

In its early stages, the condition presents no discernible symptoms. However, as the scarring intensifies, the liver gradually loses its functional capacity. When the damage becomes extensive, the condition is termed cirrhosis—a stage at which the liver is no longer able to repair itself. This can lead to liver failure, internal bleeding, and liver cancer.

According to this study, diabetes accelerates this process. High blood sugar levels, coupled with insulin resistance, promote the accumulation of fat in the liver, triggering chronic inflammation and leading to the development of fibrosis. This condition is now formally referred to as ‘Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD),’ although most people still know it as fatty liver disease. According to experts, fatty liver has reached epidemic proportions. Diabetes is a significant contributing factor to fatty liver disease.

The study revealed that individuals with Type 2 diabetes not only face a higher risk of developing fatty liver disease, but also experience a more rapid progression of severe liver scarring and cirrhosis. Consequently, for the hundreds of millions of people living with diabetes, liver disease poses an extremely serious—and often overlooked—threat. Globally, over 500 million adults are affected by Type 2 diabetes; this figure is projected to exceed 780 million by 2045, with the most significant increase anticipated in low-income countries.

India stands at the epicenter of this crisis. According to a study conducted by the Indian Council of Medical Research, 101 million people in the country are already living with diabetes, while another 136 million are in a pre-diabetic state; this combined total is expected to surpass 150 million by the middle of this century.

If diabetes is not properly managed over time, it can cause damage to various organs, including the liver. High blood sugar leads to insulin resistance and excessive fat accumulation in the liver, causing inflammation. This inflammation can progress to fibrosis, then cirrhosis, and in some cases, even liver cancer. According to Parag Rana, a contributor to the study, liver disease is emerging as a concurrent—and often silent—threat, with many patients remaining unaware of the extent of the damage they have already sustained.

Doctors state that up to two-thirds of diabetic patients may develop fatty liver, often without exhibiting any distinct symptoms. Several factors that increase this risk include: Obesity and excess weight, High cholesterol, Long-standing diabetes, Impaired kidney function

Liver disease typically progresses silently. In its early stages, there are often no symptoms, and routine blood tests do not detect fibrosis. This is where FibroScan proves invaluable (it is a painless, ultrasound-based tool that measures liver stiffness and aids in the early detection of damage). This study strongly recommends that liver screening be made a routine component of diabetes care.

Doctors emphasize that taking early action can significantly mitigate the risks. Such measures include: Increase your intake of fiber, vegetables, and lean proteins. Regular exercise helps improve insulin sensitivity. Keep your weight under control. Even a modest weight loss of 5 to 10 percent can help prevent liver complications. Alcohol damages the liver rapidly. Take your prescribed medications and always consult your doctor. Regular check-ups ensure that problems are detected in a timely manner, thereby making effective treatment possible.