Successful Example of Implementing Screening of Liver Fibrosis in Specialist Diabetes Care

Patients with type 2 diabetes (T2D) constitute a risk group for presence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD). Yet, there are few published examples of collaborations between endocrinologists and hepatologists in caring for patients with T2D and MASLD. Here, we describe a pathway for screening of liver fibrosis in routine specialist diabetes care at a tertiary care hospital.

Patients with T2D seen at the Endocrinology department at Karolinska University Hospital, Stockholm, Sweden, during a structured intervention for T2D between October 2016 and September 2023 were eligible for inclusion. Liver stiffness measurements (LSM) and controlled attenuation parameter (CAP) as proxies for liver fibrosis and steatosis, respectively, were obtained utilizing vibration-controlled transient elastography (VCTE). An LSM cut-off to exclude advanced fibrosis was set to <8 kPa. Presence of MASLD was defined as a CAP value of CAP ≥ 294 dB/m.

A total of 177 patients with a valid LSM were included. The median age was 60 years and 60% were women. The median LSM was 5.8 (interquartile range 4.6-8.1) kPa, and the median CAP was 306 (258-362) dB/m. In total, 27% had LSM ≥8 kPa and 11% had LSM ≥12 kPa. MASLD was present in 55%. The clinical score for aspartate aminotransferase, alanine aminotransferase, age, platelet count had a low sensitivity for identifying patients with VCTE measurements above 8 kPa (34%) and 12 kPa (37%).

This study provides an example of a productive partnership between endocrinologists and hepatologists using direct VCTE measurements, leading to the identification of a significant number of patients with presumed advanced fibrosis.