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Type 2 diabetes and liver disease: a frequent and harmful connection

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Patients with diabetes have a high prevalence of liver disease. The entire spectrum of liver disease is seen in patients with type 2 diabetes. Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are common conditions that regularly co-exist and act synergistically to drive negative outcomes. The classical pathway consists of initial insulin resistance, increased lipolysis, lipid accumulation in the hepatocytes, oxidative stress, and cell damage followed by fibrosis. Insulin resistance is a characteristic feature of NAFLD, as a result of increased secretion of specific proinflammatory cytokines such as TNF-α. NAFLD does not always progress to NASH, and the precise pathological events leading to steatohepatitis are yet to be determined. There is an under-recognized role of diabetes in many patients with cryptogenic cirrhosis. The prevalence of hepatocellular carcinoma is increased in patients with diabetes as well the prevalence of diabetes in patients with hepatocellular carcinoma. Patients with chronic hepatitis C are more likely to develop diabetes; all patients with type 2 diabetes and persistently elevated serum ALT should be screened for HCV testing. The majority of patients with NAFLD do not require a specific treatment. The treatment of NAFLD consists of lifestyle modification as well as pharmacological therapy. Hepatic steatosis diminishes in parallel with weight loss. Thiazolidinediones are emerging as the treatment of choice even in the absence of diabetes.

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Daniel Berceanu, Denisa Bucur and Camelia C. Diaconu

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