Nonalcoholic Fatty Liver Disease (NAFLD): Connections to Type 2 Diabetes

Nonalcoholic fatty liver disease (NAFLD) is now considered a metabolic disease. You may have heard of metabolic syndrome when learning about type 2 diabetes (T2D).¹

What is metabolic syndrome?

Metabolic syndrome is a group of changes in the body that increase blood pressure, blood sugar, and cholesterol levels. People with metabolic syndrome often have larger bodies, with much of their weight sitting around their belly. Heart disease and T2D are 2 complications of metabolic syndrome. NAFLD is considered a complication of metabolic syndrome as well.^2,3

What is nonalcoholic fatty liver disease?

NAFLD is a broad term that describes different stages of liver damage due to fat buildup. Simple steatosis is the least severe form of NAFLD. It means fat has started to build up in the liver but has not caused any damage yet.^2,3

Nonalcoholic steatohepatitis (NASH) is diagnosed if the liver becomes inflamed and damaged from fat. NASH increases the risk of other, more severe, liver diagnoses, such as cirrhosis and cancer. Cirrhosis is severe scarring of the liver. Hepatocellular carcinoma is a type of liver cancer that often occurs with cirrhosis.³

What is the link between T2D and NAFLD?

The link between T2D and NAFLD is essential to understand. People with NAFLD have a higher risk of developing T2D. People with T2D have higher rates of NAFLD than people without diabetes. Some estimates show that up to 70 percent of people with type 2 diabetes also have NAFLD.⁴

How is insulin resistance related?

Along with metabolic syndrome, insulin resistance is a connection between the 2 conditions. Insulin resistance is the body's struggle to use insulin well – a core issue in type 2 diabetes. That means medicines and treatment plans that address insulin resistance can be helpful for both T2D and NAFLD.⁵

How to reduce insulin resistance

Eating and exercise patterns, sleep and stress management, medicines, and more can help reduce insulin resistance.

A healthy eating pattern recommended by many organizations, including the American Diabetes Association, incorporates:^6,7

• Whole grains
• Fruits and vegetables
• Fish and lean meats
• Seeds and nuts

Poor sleep patterns and inactivity increase insulin resistance, so managing sleep and getting routine exercise can make a big difference in helping the body use insulin better.^6,7

Remember, health changes do not have to be extreme to be effective. Small changes can make big differences in your health.

Can medicines treat NAFLD?

While there are no drugs approved by the US Food and Drug Administration (FDA) for NAFLD, there has been support for the use of some drugs in managing it.

For example, pioglitazone (Actos^®), along with newer diabetes medications like GLP-1 agonists (Trulicity^®, Ozempic^®) and SGLT-2 inhibitors (Invokana^®, Jardiance^®), have shown promising improvements in the liver.⁴

Some of these newer diabetes drugs also cause weight loss – another recommendation for managing NAFLD. Weight loss can be difficult for many people to achieve.

Just remember that the health habits and routines listed above are helpful in lowering insulin resistance and are important parts of diabetes and NAFLD management, regardless of your body size. In short, do not give up on those healthy habits if you don't see your weight change!

Screening for NAFLD

It is important to be screened for NAFLD. NAFLD increases the risk for heart and kidney disease (like T2D), so diagnosing and managing it are important for your overall health.^1,3

Screening for NAFLD can be done in a number of ways:

• Imaging (MRI or ultrasound)
• Blood work
• Liver biopsy

A comprehensive metabolic panel shows levels of liver enzymes such as AST and ALT. Your doctor can use these results, along with other labs and your age, to calculate things like FIB-4 (a formula that helps your provider rule out or identify liver scarring).

Because of the link between NAFLD and T2D, discuss NAFLD screenings with your provider at your next visit.