Diabetes and Fatty Liver

Fatty liver disease is extremely common in Type 2 diabetes and rarely discussed at diabetes appointments. Studies suggest between a third and two-thirds of people with Type 2 diabetes have it.

The condition — non-alcoholic fatty liver disease, now often called metabolic dysfunction-associated steatotic liver disease — means excess fat has built up in the liver in someone who does not drink heavily.

Why it matters

There are two forms, and the difference is important:

• Simple fatty liver, where there is fat but little inflammation. This usually does not progress.
• NASH, where there is inflammation and liver damage as well as fat. This can advance to cirrhosis and liver cancer, and in some cases to needing a transplant.

It is usually silent. Most people have no symptoms, and it is typically found incidentally — on an ultrasound done for something else, or through abnormal liver enzymes on a routine blood test.

If a scan has ever mentioned a fatty liver, do not file it as unimportant. Ask what form it is, whether liver enzymes are raised, and whether it needs following up.

What helps is what helps the diabetes: gradual weight loss, regular activity, reducing refined carbohydrate and alcohol. There is no separate pill for it in most cases — the treatment and the diabetes treatment are largely the same project.