Low awareness of non-alcoholic fatty liver disease in patients with type 2 diabetes in Swedish Primary Health Care

Non-alcoholic fatty liver disease (NAFLD) is more common in patients with type 2 diabetes mellitus (T2DM) compared to individuals without. Recent guidelines recommend screening for NAFLD in patients with T2DM. Our aim was to investigate the prevalence of NAFLD in patients with T2DM in a Swedish primary health care setting, how they are cared for and assess the risk of biochemical signs of advanced fibrosis. In this cohort study, patients with T2DM from five primary health care centers were included. Medical records were retrospectively reviewed and living habits, medical history, results of diagnostic imaging and anthropometric and biochemical features were noted in a standardized form. The risk of steatosis and advanced fibrosis was assessed using commonly used algorithms (FLI, HSI, NAFLD-LFS, NAFLD ridge score, FIB-4 and NFS). In total 350 patients were included. Diagnostic imaging had been performed in 132 patients and of these, 34 (26%) had steatosis, which was not noted in the medical records in 16 (47%) patients. One patient with steatosis had been referred to a hepatologist. Of assessable patients, 71–97% had a high to intermediate risk of steatosis and 29–65% had an intermediate to high risk of advanced fibrosis according to the algorithms used. This study indicates a high prevalence of NAFLD among T2DM patients in Swedish primary care. Patients with known NAFLD were followed up to a very low extent. Using fibrosis algorithms in primary health care would result in many patients needing further assessment in secondary care.

非酒精性脂肪性肝病（Non-alcoholic fatty liver disease, NAFLD）在2型糖尿病（type 2 diabetes mellitus, T2DM）患者中的发病率高于非糖尿病人群。现行临床指南推荐对2型糖尿病患者开展非酒精性脂肪性肝病筛查。本研究旨在调查瑞典初级卫生保健环境下2型糖尿病患者中非酒精性脂肪性肝病的患病率、患者的照护现状，并评估其进展性纤维化生化体征的风险。本队列研究纳入了来自5家基层医疗卫生中心的2型糖尿病患者，研究人员对患者的病历资料进行回顾性审查，以标准化表单记录患者的生活习惯、病史、诊断影像学检查结果，以及人体测量学与生化特征。研究采用临床常用算法：脂肪变指数（Fatty Liver Index, FLI）、肝脂肪变指数（Hepatic Steatosis Index, HSI）、非酒精性脂肪性肝病预后评分（Non-alcoholic Fatty Liver Disease Liver Fibrosis Score, NAFLD-LFS）、非酒精性脂肪性肝病岭评分（NAFLD ridge score）、FIB-4指数、非酒精性脂肪性肝病纤维化评分（NAFLD Fibrosis Score, NFS），评估患者的脂肪变与进展性纤维化风险。本研究共纳入350例患者，其中132例患者接受了诊断影像学检查，34例（26%）检出脂肪变，而其中16例（47%）的脂肪变情况未在病历中记录。仅1例确诊脂肪变的患者被转诊至肝病专科医师处。根据所采用的风险算法，可评估患者中71%~97%存在脂肪变高-中度风险，29%~65%存在进展性纤维化中-高度风险。本研究结果表明，瑞典基层医疗环境下的2型糖尿病患者中非酒精性脂肪性肝病患病率较高。已知罹患非酒精性脂肪性肝病的患者随访率极低。在基层医疗中应用纤维化风险算法，将导致大量患者需要在二级医疗中接受进一步评估。