The ADA now advises universal screening of people with type2diabetes and prediabetes for fatty liver disease and provides new recommendations for management in those with the condition, or who are at risk for it. ADA2023
Isaacs, who chaired the AACE guidance writing panel, noted,"The ADA update essentially repeats the same guidance in the AACE and AASLD documents. It is excellent to see this type of alignment of guidance among the major organizations."The ADA now advises screening all adults with type 2 diabetes or prediabetes, particularly those with obesity or cardiometabolic risk factors or established cardiovascular disease — even those with normal liver enzyme levels.
Indeed, Isaacs said,"The FIB-4 is a simple…great screening test because it is essentially free." But he cautioned that it has some limitations. The ADA update also provides guidance on follow-up for patients flagged with the FIB-4, including when referral to a gastroenterologist or hepatologist is appropriate.Lifestyle modification is recommended for all adults with diabetes or prediabetes and NAFLD, particularly those with overweight or obesity.
However, insulin is the preferred treatment for hyperglycemia in adults with type 2 diabetes who have decompensated cirrhosis.
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