ADA Updates Guidelines on NAFLD Screenings for Diabetic Patients

As an addendum to guidelines published in December 2022, the American Diabetes Association (ADA) has updated its screening guidelines for nonalcoholic fatty liver disease (NAFLD) in diabetic patients. Adding to the existing Standards of Care in Diabetes, the updates amend section four of the guidance: “Comprehensive Medical Evaluation and Assessment of Comorbidities.”

"Diabetes and liver disease are closely linked, and it is essential that healthcare professionals have the most current information to effectively detect and manage this disease," said Nuha ElSayed, MD MMSc, the overseer of the ADA standards of care guidelines and chair of the professional practice committee, in the ADA press release.

Roughly 70% of patients with type 2 diabetes (T2D) are impacted by liver disease. Most notably, nonalcoholic fatty liver disease, including nonalcoholic steatohepatitis (NASH), has the most significant impact on diabetic patients.

Left untreated, NAFLD can result in cirrhosis, liver cancer, elevated risk of cardiovascular disease, and death. Considering the potentially destructive nature of NAFLD and the high risk among diabetic patients, the ADA emphasizes the importance of screenings for prompt diagnosis and treatment.

Under section four of the guidance, three addendums were made, including changes to the classification and diagnosis of diabetes, prevention and delay of type 2 diabetes, and medical evaluations and assessments of comorbidities.

Addendum four in section four includes detailed recommendations for NAFLD screening. The new recommendations suggest that all adults with T2D or prediabetes be screened for NAFLD using a calculated fibrosis-4 index. Additionally, the ADA notes that diabetic and prediabetic patients with elevated plasma aminotransferase levels and low fibrosis index should be assessed for the condition.

"Liver disease is increasingly being recognized as a major complication of diabetes," said Robert Gabbay, MD, PhD, FACP, and Chief Scientific and Medical officer at the ADA, in the statement. "ADA is committed to preventing and curing diabetes, a complex, chronic illness that requires continuous medical care. For more than 30 years, ADA has been actively involved in the development of clinical practice recommendations that clinicians, researchers, health plans, policymakers, and others can rely on to guide diabetes care."