Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease

Abstract

Type 2 diabetes is associated with a large number of liver disorders including elevated liver enzymes, fatty liver disease, cirrhosis, hepatocellular carcinoma, and acute liver failure. In addition, there is an unexplained association with HCV. The SMR for cirrhosis is higher than that for CVD in type 2 diabetes. Many consider NAFLD to be part of the insulin resistance syndrome. However, the presence of liver disease (unless decompensated) has little implication for the specific treatment of diabetes, and the presence of diabetes has little implication for the specific treatment of liver disease. Patients with decompensated liver disease are more susceptible to hypoglycemia and require careful monitoring. There continues to be a need for long-term placebo-controlled trials for the treatment of NAFLD and for the treatment of diabetes in patients with liver disease. © 2007 by the American Diabetes Association.