Non-alcoholic fatty liver disease and type 2 diabetes Management and treatment

Background Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide and is closely related to type 2 diabetes (T2D), its comorbidities and sequelae. The simultaneous presence of both NAFLD and T2D increases liver-related and also vascular morbidity and mortality of affected individuals. Objective Strategies for diagnosis and treatment of NAFLD in patients with T2D are presented. Material and methods The results of relevant original papers and review articles as well as guideline recommendations are described and discussed. Results Liver biopsy is the gold standard for the diagnosis of NAFLD, but non-invasive procedures are usually preferred due to their lower risk for patients. The NAFLD and also the cardiovascular risk can be positively modulated by antihyperglycemic agents. Other substances for the targeted treatment of NAFLD in patients with and without T2D are in clinical development. Conclusion Non-invasive methods for the exact staging of NAFLD are not yet available in daily practice, which is why liver biopsy remains the method of choice for the assessment of inflammation and fibrosis in high-risk patients. Screening tools for NAFLD comprise ultrasound, transaminases and fatty liver indices. The targeted antihyperglycemic treatment and combined treatment with antihyperglycemic agents and/or other substances may provide the basis for an effective treatment of NAFLD in T2D.