Evaluation of the prevalence and management of non alcoholic fatty liver disease in patients with type 2 diabetes mellitus at a teaching hospital: Are the guidelines being followed?

Non alcoholic fatty liver disease (NAFLD) is a chronic liver disease characterised by insulin resistance and the accumulation of fatty acids in the liver. Studies suggest that two thirds of patients with obesity and type 2 diabetes mellitus (DM) may have NAFLD. The aim of this audit was to ascertain the prevalence of NAFLD in patients with Type 2 DM attending the Out-patient Department of a large teaching hospital and to compare their management with the American Association for the Study of Liver Diseases guidelines.1 A retrospective cross sectional study was conducted. Using an inclusion and exclusion criteria, 151 Type 2 DM patients were randomly selected from a database. Subject demographics were recorded such as gender, age, BMI, alcohol consumption and smoking, Aminotransferase levels, confirmed NAFLD, dyslipidemia status and medications. The mean age was 61 years, 57 % were male and the mean BMI was 33.2 kg m2. The prevalence of NAFLD was 7 % (n = 10). A further 3 % (n = 4) had incidental findings of fatty liver on radiological imaging. No statistical significance was found between abnormal transaminases and NAFLD (p = 0.405), dyslipidemia and NAFLD (p = 0.426), and obesity and NAFLD (p = 0.466). Six subjects used pioglitazone; these patients did not have NAFLD. None of the subjects used Vitamin E. In conclusion, the Endocrine department is following the standards which do not recommend screening patients with Type 2 DM for NAFLD.1 The prevalence of NAFLD was lower than expected which may have been due to the lack of screening and/or the insensitivity of current tests.