Liver Disease Identified As the 'Fourth Major Complication' Of Diabetes, Says Lancet Study

Diabetes is a condition wherein the pancreas is unable to produce enough insulin or when the body cannot use insulin effectively. This causes your blood sugar levels to increase since insulin is a hormone that regulates your blood sugar levels. This eventually leads to hyperglycemia, or high blood sugar levels. And when you have high blood sugar levels persistently, it leads to diabetes. The condition is known to cause severe damage in the long-term such as eye damage, kidney failure, and nerve pain. Now, a new study in The Lancet Regional Health Southeast Asia says that liver disease should be seen as the fourth big complication of diabetes.

This comes from India's largest survey of liver health in people with type 2 diabetes. For this, researchers analysed over 9,000 patients using a tool called FibroScan, which measures liver stiffness without needles or surgery. They found that 26% have significant liver scarring, called fibrosis, and 5% may already have cirrhosis, the advanced stage where the liver is severely damaged.

Study Overview

The DiaFib-Liver Study ran from January to July 2024 across 27 centers in India, including big hospitals like Sir Ganga Ram in Delhi and Madras Diabetes Research Foundation in Chennai. It focused on adults with type 2 diabetes who were not getting liver treatment and had no symptoms yet. Even then, 14% of them showed advanced fibrosis, highlighting that the damage is sometimes hidden.

What surprised experts is that fibrosis was present even in those without fatty liver buildup. About 13% of patients with no detectable fat still had scarring, including 4% at cirrhosis levels. This means that standard checks for fat tend to miss several people at risk. The study calls for routine fibrosis screening in diabetes care, like checking eyes or kidneys.

Dr Parag Rana, a Vadodara-based diabetologist and a contributor to the study, said, "This is a significant shift in our understanding of diabetes complications. Liver disease is emerging as a parallel and often silent threat, and many patients may already have advanced damage without knowing it."

Rana also said, "There is a clear need to integrate liver fibrosis screening into routine diabetes care so that cases can be detected early."

Why Diabetes Harms the Liver

High blood sugar from diabetes leads to insulin resistance, where the body stores too much fat in organs like the liver. Over time, this fat causes inflammation, then fibrosis, and finally cirrhosis or liver cancer if unchecked. India has over 100 million diabetics and this study suggests that this threat could affect millions. Risk factors include obesity, high cholesterol, long diabetes duration, and poor kidney function.

Speaking to NDTV, Dr Mahesh Gupta, Director- Gastroenterology, Fortis Hospital Noida, who was not involved in the study, said, "Diabetes is one of the most prevalent chronic illnesses and up to two third of these patients have fatty liver, which is nowadays recognized as the fourth complication of diabetes."

Occurrence of fatty liver is more common in obese and overweight people but in those who have diabetes, it can occur even in normal weight people. Fatty liver over years progresses to liver inflammation and damage as fibrosis. This damage and fibrosis over years increases and becomes irreversible called cirrhosis and even liver cancer. In most of the cases, fatty liver is a silent disease and patients might feel only minor symptoms like fatigue or mild weakness.

Signs and Screening

Liver fibrosis is sneaky as there's no pain, fatigue, or yellow skin until the disease reaches late stages. Routine blood tests often miss it. Hence, FibroScan is important. It uses ultrasound waves to score stiffness: higher scores mean more fibrosis. India's national diabetes programs should add liver checks.

Preventive Measures

Manage diabetes with diet, exercise, and medicine to reduce the risks of liver damage. Lose weight if you're overweight, even 5-10% can be helpful. Eat more fibre, vegetables and lean protein. Cut sugars and fried foods. Along with a healthy diet, quit alcohol completely, as it worsens liver damage.

Dr Gupta said that early detection and timely management of fatty liver is important for patients with diabetes. The mainstay of treatment is lifestyle modifications, like maintaining a healthy weight and balanced diet, which help in managing both diabetes and fatty liver effectively. In advanced cases, addition of medications also helps in improving the condition. Regular monitoring of liver functions by blood tests, imaging like ultrasound of abdomen and fibroscan is recommended for obese people and people with diabetes. "All patients with diabetes should be screened yearly for presence of fatty liver so that timely management can be done," added Dr Gupta.

Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.