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Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes

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Diabetes and Exercise

Part of the book series: Contemporary Diabetes ((CDI))

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Abstract

Nonalcoholic fatty liver disease (NAFLD) is a growing problem likely to worsen worldwide with the epidemic of obesity. Insulin resistance in obesity drives a constellation of metabolic abnormalities that create a state known as “lipotoxicity,” in which the liver is uniquely posed to be affected (Cusi K, Gastroenterology 142:711–25 e6, 2012; Neuschwander-Tetri BA, Hepatology 52:774–88, 2010). Additional factors that appear to play a role are chronic hyperglycemia and subclinical inflammation. As the vast majority of patients with type 2 diabetes mellitus (T2DM) are obese, they are particularly susceptible to develop NAFLD and to have a worse long-term prognosis. The disease can present itself as a quiescent condition with hepatic triglyceride accumulation with minimal or no inflammation or adopt a more aggressive phenotype associated with hepatocellular injury, marked inflammation, and fibrosis (known as nonalcoholic steatohepatitis or NASH) (Ahmed A, Wong RJ, Harrison SA, Clin Gastro Hepatol 13:2062–70, 2015). These patients are at a much higher risk of cirrhosis, as well as of hepatocellular carcinoma (Wang C, Wang X, Gong G, et al., Int J Cancer 130:1639–48, 2012).

Disclosure Statement:

K.C. has received research support from Janssen, Novartis, and Octeta and served as a consultant for (in alphabetical order) Janssen, Lilly, Novo Nordisk, Octeta, Pfizer, and Tobira Therapeutics, Inc.

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Abbreviations

1H-MRS:

Proton magnetic resonance spectroscopy

Adipo-IR:

Adipose tissue insulin resistance

ALT:

Alanine aminotransferase

AST: ALT:

Aspartate aminotransferase

BMI:

Body mass index

CT:

Computed tomography

CVD:

Cardiovascular disease

DNL:

De novo lipogenesis

DPP-4:

Dipeptidyl peptidase-4

GLP-1RA:

Glucagon-like peptide-1 receptor agonist

HbA1C :

Hemoglobin A1c

HCC:

Hepatocellular carcinoma

IHTG:

Intrahepatic triglycerides

NAFLD:

Nonalcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Nonalcoholic steatohepatitis

PPAR:

Peroxisome proliferator-activated receptor

PUFAs:

Polyunsaturated fatty acids

RCT:

Randomized controlled trials

SGLT2:

Sodium-glucose co-transporter 2

T2DM:

Type 2 diabetes mellitus

TZDs:

Thiazolidinediones

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Florida College of Medicine, 1600 SW Archer Road, room H-2, Gainesville, FL, 326100, USA

    Kenneth Cusi MD, FACP, FACE

  2. Division of Endocrinology, Diabetes, and Metabolism, Malcom Randall Veterans Affairs Medical Center, Gainesville, FL, USA

    Kenneth Cusi MD, FACP, FACE

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  1. Kenneth Cusi MD, FACP, FACE
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Correspondence to Kenneth Cusi MD, FACP, FACE .

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Editors and Affiliations

  1. Department of Medicine, Division of Endocrinology Metabolism and Diabetes and Center for Women’s Health Research, University of Colorado, Aurora, Colorado, USA

    Jane E. B. Reusch, MD

  2. Department of Medicine, Division of General Internal Medicine and Center for Women’s Health Research, University of Colorado School of Medicine, Aurora, Colorado, USA

    Judith G. Regensteiner, PhD, MA, BA

  3. Clinical and Research Exercise Physiology, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

    Kerry J. Stewart, Ed.D., FAHA, MAACVPR, FACSM

  4. Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Aristidis Veves, MD, DSc

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Cusi, K. (2018). Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes. In: Reusch, MD, J., Regensteiner, PhD, MA, BA, J., Stewart, Ed.D., FAHA, MAACVPR, FACSM , K., Veves, MD, DSc, A. (eds) Diabetes and Exercise. Contemporary Diabetes. Humana Press, Cham. https://doi.org/10.1007/978-3-319-61013-9_4

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  • DOI: https://doi.org/10.1007/978-3-319-61013-9_4

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