Clear, evidence-based guidelines needed for NAFLD in type 2 diabetes
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New findings published in Diabetic Medicine highlighted the urgent need for clear, evidence-based guidelines for managing nonalcoholic fatty liver disease in individuals with type 2 diabetes.
“In addition to providing evidence-based pathways, implementing an assessment of liver fibrosis into primary health care requires clinicians to carry out this guidance,” Elizabeth E. Powell, MBBS, PhD, Centre for Liver Disease Research in the Translational Research Institute at the University of Queensland and the department of gastroenterology and hepatology at Princess Alexandra Hospital in Brisbane, Queensland, Australia, and colleagues wrote. “Although awareness of nonalcoholic fatty liver disease (NAFLD) guidelines has been surveyed, few studies have explored clinicians’ perceived barriers and facilitators to NAFLD management.”
Researchers recruited 19 health practitioners from multidisciplinary diabetes clinics in three primary care and one hospital setting in Australia. Of these, nine were general practitioners, seven were endocrinologists and endocrine advanced trainees and three were diabetes educators. Through four focus groups using semi-structured interviews about managing NAFLD, researchers identified common themes surrounding barriers to managing NAFLD for individuals with type 2 diabetes, including diagnosis, assessment and management.
All focus groups noted a lack of knowledge and access to proper resources as key factors that support inconsistent approaches to NAFLD diagnoses and risk stratification. These factors also affected clinician confidence in discussing NAFLD diagnoses with their patients. Oftentimes, other medical issues were prioritized above NAFLD due to the lack of concern surrounding liver-related consequences to diabetes, reluctance to overburden patients with information, lack of time and the perceived absence of available fibrosis tests.
Every participant suggested that implementing a NAFLD management pathway would improve patient care. In addition, general practitioners recommended screening for NAFLD in routine review cycles for patients with type 2 diabetes.
Researchers also observed a consistent message of the importance to educate patients about liver disease requirements in integrated care pathways.
“By focusing on comorbidity prevention and integrating NAFLD as a diabetes complication to be addressed during established cycles of care, many barriers to implementing a NAFLD pathway in primary care could be overcome,” the researchers wrote.
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