People with type 2 diabetes should be closely monitored to avoid developing liver disease, researchers behind a study of 18 million people have urged.

Liver cirrhosis and liver cancer can be identified late, often at advanced stages, and those with type 2 diabetes and liver disease are more than twice as likely to develop an aggressive form of the disease, according to the findings of a European study.

While people with diabetes face an increased risk of complications, maintaining healthy blood glucose levels, eating a real-food diet and getting regular physical activity can delay or in some cases even prevent complications developing.

A team of researchers led by Queen Mary University of London and the University of Glasgow made the conclusions after combing through the health records of 18 million adults living in UK, Netherlands, Spain and Italy.

They were looking for cases of non-alcoholic fatty liver disease (NAFLD), which is the most common cause of liver disease globally. NAFLD is also linked to greater risks of obesity and type 2 diabetes.

NAFLD is not always detected in its early stages, leading to many people going undiagnosed. The condition is benign at an early stage, but one in six people go on to get non-alcoholic steatohepatitis (NASH), a more aggressive stage of the disease. NASH can lead to injury of the liver, scarring and potentially cirrhosis as well as liver failure and in some cases liver cancer. Picking up NAFLD early ensures people who develop NASH can be treated early to improve outcomes.

In this study, the research team identified people with NAFLD and then compared them to 100 people without a recorded diagnosis, seeing who went on to liver cirrhosis and liver cancer over a period of time.

Over 136,000 people with NAFLD/NASH were picked up, and people who had type 2 diabetes and NAFLD/NASH were more than twice as likely to develop aggressive liver disease.

According to the findings, people with NAFLD/NASH who went on to develop life-threatening liver disease did so at an average of 3.3 years after diagnosis, although this may be down to a late diagnosis rather than a speedy rate of disease progression.

Dr William Alazawi, who was the lead researcher, said: “The public, doctors and policy makers need to be aware of this silent disease and strategies need to be put in place to tackle the root causes and avoid progression to life-threatening stages.

“People living with [type 2] diabetes are at increased risk of more advanced, life threatening stages of disease, suggesting that we should be focusing our efforts in educating and preventing liver disease in diabetes patients.”

The research was published in the journal BMC Medicine and was funded by the European Union as well as the Medical Research Council.

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