Revolutionary Study:combining Eye and Liver Screenings for Type 2 Diabetes Patients
A recent study published in Lancet Gastroenterology and Hepatology suggests a novel approach to screening for liver fibrosis in patients with Type 2 diabetes (T2D). The study, conducted in Sweden, proposes combining eye screening with elastography — a non-invasive, non-radiation diagnostic technique that measures liver stiffness.
The Growing Concern: Non-Alcoholic Fatty Liver Disease (NAFLD)
Sugar-rich diets and sedentary lifestyles have led to a global epidemic of non-alcoholic fatty liver disease (NAFLD), also known as metabolic associated fatty liver disease (MAFLD). Approximately 38% of the world’s population is affected by NAFLD, which significantly increases the risk of liver cancer and end-stage liver disease. T2D patients are particularly vulnerable, with a 65% prevalence rate.
While the Fibrosis-4 (FIB-4) score is commonly used for NAFLD diagnosis, its accuracy is lower in T2D patients. As such, alternative non-invasive methods like vibration-controlled transient elastography (VCTE), magnetic resonance elastography with two metabolic risk factors, and enhanced liver fibrosis (ELF) score are being explored.
The Swedish Eye on Diabetes
In Sweden, T2D patients undergo regular eye screenings at designated units, where fundus photography intervals detect diabetic retinopathy. This rutine could be expanded to include liver screening using VCTE, potentially detecting advanced fibrosis and NAFLD simultaneously.
Study Details and Findings
The study, conducted between November 2020 and June 2023 at Capio Eye Globen in Stockholm, enrolled 1,655 T2D patients. After exclusions, 1,005 patients agreed to simultaneous liver screening with VCTE. The average age was 67.3 years, with 37.1% being female.
Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) values were recorded. LSM ≥8 kPa indicated advanced fibrosis, while CAP ≥280 dB/m signified NAFLD. Follow-up VCTE scans were conducted on patients with elevated LSM.
Key findings include:
- 1005 patients were screened, with 51.8% having CAP values indicating NAFLD.
- 82% of patients had VCTE values below 8 kPa, with 4.9% above 12 kPa.
- 16.4% were referred to the liver unit, while 9% were not due to old age or severe comorbidities.
- A weak positive correlation was seen between first and second VCTE LSM.
- Risk factors for increased LSM included high CAP, Body Mass Index (BMI), and severe retinopathy.
Implications
Incorporating VCTE into existing eye screening protocols for T2D patients could revolutionize liver fibrosis detection. However, clinicians should be mindful of potential false positives if this approach is adapted into routine care.
Worth a look