A recent nationwide study has identified a significant yet often overlooked health risk among people with Type 2 diabetes in India—hidden liver fibrosis. The findings reveal that a substantial proportion of diabetic patients may already have liver damage without showing noticeable symptoms.
DiaFib-Liver Study Highlights a Growing Health Concern
According to the DiaFib-Liver Study, which examined more than 9,000 adults with Type 2 diabetes across diverse regions of India, one in four patients has clinically significant liver fibrosis.
As reported by The Hindu Businessline, the research was published in The Lancet Regional Health – Southeast Asia and was conducted between January and July 2024. A team of 48 physicians, diabetologists, and endocrinologists carried out the study under the Diabetes and Liver Interest Group of Diabetes India. The study was led by Dr Ashish Kumar, a gastroenterologist based in Delhi.
Largest Real-World Survey in a Low- and Middle-Income Country
Experts note that the study represents one of the largest real-world assessments of liver fibrosis among diabetic patients in a low- or middle-income country.
Faraz Farishta, Professor and Director of FS Endocrine and Diabetic Centres, highlighted the importance of the research.
“It is the largest real-world survey of liver fibrosis in diabetic patients ever conducted in a low- or middle-income country. Importantly, participants were recruited from routine diabetes care settings rather than specialised liver clinics, which makes the findings highly relevant to everyday clinical practice,” he said.
Significant Proportion Shows Advanced Liver Damage
The study revealed alarming statistics about the prevalence of liver damage among diabetic patients.
About 26% of patients (around 2,400 individuals) had clinically significant liver fibrosis.
Approximately 14% had advanced fibrosis.
One in twenty patients already showed signs of probable cirrhosis, despite having no symptoms of liver disease.
These findings suggest that silent liver damage may be far more common among diabetic patients than previously recognised.
Liver Fibrosis Found Even in Non-Obese Patients
Interestingly, researchers observed that liver fibrosis was present even among individuals who were not obese and in those without fatty liver detected through imaging tests.
However, the study identified several factors that increase the risk of liver fibrosis in people with diabetes. These include:
Obesity
Dyslipidaemia (abnormal cholesterol levels)
Reduced kidney function
Longer duration of diabetes
These factors independently contributed to the likelihood of developing liver fibrosis.
Liver Disease Often Overlooked in Diabetes Care
India currently has over 10 crore adults living with Type 2 diabetes, making it one of the largest diabetic populations globally. Despite this, diabetes management has traditionally focused on blood sugar control and well-known complications such as retinopathy, neuropathy, and kidney disease.
According to Farishta, liver disease has largely remained neglected because it progresses silently without early symptoms.
“The DiaFib-Liver Study shows that liver fibrosis is at least as common as other established complications of diabetes. However, it is rarely screened for in routine diabetes care,” he explained.
Experts Call Liver Disease the ‘Fourth Major Complication’ of Diabetes
Given the findings, researchers recommend that liver disease should be recognised as the fourth major complication of diabetes, alongside complications affecting the heart, brain, and kidneys.
They emphasise the need to include non-invasive liver fibrosis screening in routine diabetes management.
Early Detection Can Prevent Serious Complications
Experts also recommend the use of non-invasive diagnostic tools such as FibroScan to detect liver fibrosis early. Identifying high-risk patients at an early stage could help doctors initiate timely treatment and prevent disease progression.
“A timely diagnosis followed by appropriate intervention can potentially prevent fibrosis from progressing to cirrhosis or liver failure,” Farishta added.
Strengthening Screening in Diabetes Care
Overall, the study underscores the urgent need to expand the scope of diabetes care beyond blood sugar management. By incorporating regular liver health screening, healthcare providers can detect complications earlier and improve long-term outcomes for millions of patients living with diabetes in India.
Source : Theindianpractitioner
