Diabetes and NAFLD

Type 2 diabetes and nonalcoholic fatty liver disease (NAFLD) are common diseases that often coexist and may act synergistically to drive adverse hepatic and extrahepatic clinical outcomes. NAFLD affects up to 70-75% of patients with type 2 diabetes and approximately 30–40% of adult patients with type 1 diabetes. In patients with diabetes, the presence of NAFLD is associated with poorer glycemic control, more severe hyperinsulinemia, atherogenic dyslipidemia, and adipose tissue/hepatic insulin resistance compared with patients without NAFLD. The coexistence of NAFLD and diabetes increases the risk of developing both microvascular and macrovascular complications of diabetes as well as increasing the risk of developing more severe forms of NAFLD (nonalcoholic steatohepatitis, advanced fibrosis, and cirrhosis). In addition, patients with NAFLD and diabetes have an increased risk of all-cause and cause-specific (cardiovascular, cancer, and liver) mortality compared with those without NAFLD. The mainstay of NAFLD management among patients with diabetes is currently to maintain a healthy body weight, improve glycemic control and reduce the modifiable cardiometabolic risk factors. This chapter briefly discusses the diagnosis of NAFLD, the epidemiology, and natural history of NAFLD in patients with diabetes, the potential adverse effects of NAFLD on glycemic control, and the risk of chronic complications of diabetes (principally cardiovascular disease and chronic kidney disease). This chapter also critically evaluates the available treatment options for NAFLD, with the aim of helping to inform the reader as to the most pertinent issues when managing patients with coexistent NAFLD and diabetes.