Commentary
The authors hypothesized that screening for NAFLD in type 2 diabetes (T2D) patients, starting with ultrasound (US) and alanine aminotransferase (ALT) or aspartate aminotransferase (AST), followed with non-invasive testing for fibrosis to detect those most likely to have fibrosis stage ≥F2, is more cost effective than not screening this population.
The authors developed a Markov model to test various screening strategies and treatment for NASH in T2DM.
Patients identified as NASH ≥F2 following screening approaches and underwent a 1-year duration intensive lifestyle intervention (ILI). In an exploratory analysis, those with NASH ≥F2.
Patients were alternatively treated with pioglitazone until death or treatment non-adherence. Screening strategies 3 and 6 were also cost effective with pioglitazone as the treatment intervention. Screening strategy 3: If US+ALT suspected likely fatty liver, US+ALT was followed by transient elastography, with 1-year ILI prescribed to suspected patients (NASH stage ≥2). Screening strategy 6: If US+AST suspected likely fatty liver, US+AST was followed by transient elastography, with 1-year ILI prescribed to suspected patients (NASH stage ≥2).
The authors conclude the results indicate the potential value and cost effectiveness of NAFLD screening in T2D persons. Given the increasing burden of NAFLD/NASH and the expected rapid increase in approved medications, they recommend screening patients with T2D for NAFLD.
