Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver.
Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.”
Fatty Liver Disease and Type 2 Diabetes: The Connection
Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains.
Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis.
Fatty Liver Disease Diagnosis
Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ultrasound.
Einhorn says that fatty liver disease is not treated as a separate disease; therefore, doctors do not usually pin down the diagnosis with any additional studies unless liver enzymes are elevated unexpectedly, such as in a person without diabetes or obesity, or if the levels are very high and it appears that something else may be going on.
Fatty Liver Disease Treatment
There are no drugs that treat fatty liver disease. Instead, this condition is treated indirectly with lifestyle changes such as losing weight, getting in better physical shape, and controlling blood sugar and triglycerides — fats in the blood that can contribute to fatty liver. “You try to get the best possible control and hope that the fatty liver responds to that control,” says Einhorn.
Diabetes medications known as “insulin sensitizers” have been shown to have an effect in reducing fat in the liver; these include thiazolidinediones or glitazones such as pioglitazone (Actos) and rosiglitazone (Avandia), which are used to treat insulin resistance. It makes sense to use them if insulin resistance is part of fatty liver, explains Einhorn, but they are not U.S. Food and Drug Administration-approved for treating fatty liver disease.
Fatty Liver Disease Prevention
Type 2 diabetes, obesity, and fatty liver disease seem to go hand-in-hand. But it is not a given that if you have type 2 diabetes you will automatically develop fatty liver disease. Since obesity, insulin resistance, and high levels of triglycerides in the blood increase the risk of fatty liver disease, treating these other conditions can prevent its development.
Maintaining a healthy weight or losing weight if you are overweight or obese; exercising regularly; and controlling your blood sugar and triglyceride levels will go a long way toward safeguarding against fatty liver disease.