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A groundbreaking study from Karolinska Institutet in Sweden suggests that screening for liver damage could be integrated into existing eye disease screenings for people with type 2 diabetes. The research, published in The Lancet Gastroenterology & Hepatology, highlights the potential for simultaneous detection of liver fibrosis and diabetic eye complications, offering a novel approach to managing the long-term health of diabetic patients.
Type 2 diabetes is commonly associated with metabolic dysfunction, leading to conditions like steatotic (fatty) liver disease. This condition affects over half of all people with diabetes, but it often remains undiagnosed because it shows few symptoms in its early stages. Without intervention, fatty liver disease can progress to liver fibrosis, cirrhosis, or even liver cancer.
Currently, international guidelines recommend screening for liver fibrosis in individuals at high risk, including those with type 2 diabetes. However, liver disease is often diagnosed too late, when treatment options are limited.
Hannes Hagström, adjunct professor at Karolinska Institutet and consultant in hepatology at the Karolinska University Hospital, explains, “Severe liver disease is often detected too late when the prognosis is poor. With an approved treatment for steatotic liver disease with fibrosis, it would be beneficial to detect it earlier in diabetic patients.”
In Sweden, retina scanning, or fundus photography, is already part of an established screening program for diabetic eye damage. In this innovative study, Hagström and colleagues explored the possibility of using elastography, a quick and painless ultrasound technique, to screen for liver fibrosis during the same appointment.
Elastography takes just 5 to 10 minutes and can potentially detect liver fibrosis before it progresses to more severe stages. “This approach could allow us to screen for both conditions at once, identifying liver fibrosis early and preventing severe complications like cirrhosis or liver cancer,” Hagström says.
The study involved more than 1,300 people with type 2 diabetes who underwent retina scanning. The researchers asked participants if they would also consent to liver elastography screening. Remarkably, 77% of participants (over 1,000 people) agreed to the combined screening.
The results showed that 15.8% of those screened for liver fibrosis had findings suggesting the presence of fibrosis, and 5.0% had signs of advanced fibrosis or cirrhosis. However, a follow-up reassessment showed lower figures—7.4% with fibrosis and 2.9% with advanced fibrosis—indicating that some initial findings were false positives. This is likely due to patients not fasting as instructed prior to the first screening, an important factor for accurate results.
“The high rate of false positives in the initial round shows that we need to refine the screening process,” Hagström explains. “The next step will involve conducting health economic analyses to evaluate if combining eye and liver screenings would be a cost-effective strategy.”
As the global prevalence of type 2 diabetes continues to rise, this dual screening approach could have significant implications for the early detection and prevention of two common but often overlooked complications. By detecting liver fibrosis earlier, clinicians could offer timely interventions to reduce the risk of more severe liver disease, ultimately improving outcomes for diabetic patients.
The study is titled Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: a cross-sectional study and is available in The Lancet Gastroenterology & Hepatology (2024).
