Feasibility and efficiency of European guidelines for NAFLD assessment in patients with type 2 diabetes: A prospective study

Giulia Besutti, Lisa Bonilauri, Elisa Manicardi, Francesco Venturelli, Efrem Bonelli, Filippo Monelli, Valeria Manicardi, Luca Valenti, Guido Ligabue, Susanna Schianchi, Marco Massari, Nicoletta Riva, Elisabetta Froio, Elena Tagliavini, Pierpaolo Pattacini, Paolo Giorgi Rossi

Research output: Contribution to journalArticlepeer-review


Aim: We aimed to evaluate the feasibility and efficiency of a guidelines-compliant NAFLD assessment algorithm in patients with newly diagnosed type 2 diabetes (T2D). Methods: Consecutive patients aged < 75 newly diagnosed with T2D without coexisting liver disease or excessive alcohol consumption were enrolled. Patients were stratified based on liver enzymes, fatty liver index, ultrasound, fibrosis scores and liver stiffness measurement. Referral rates and positive predictive values (PPVs) for histological non-alcoholic steatohepatitis (NASH) and significant fibrosis were evaluated. Results: Of the 171 enrolled patients (age 59 ± 10.2 years, 42.1% females), 115 (67.3%) were referred to a hepatologist due to abnormal liver enzymes (n = 60) or steatosis plus indeterminate (n = 37) or high NAFLD fibrosis score (n = 18). Liver biopsy was proposed to 30 patients (17.5%), but only 14 accepted, resulting in 12 NASH, one with significant fibrosis. The PPV of hepatological referral was 12/76 (15.8%) for NASH and 1/76 (1.3%) for NASH with significant fibrosis. The PPV of liver biopsy referral was 12/14 (85.7%) for NASH and 1/14 (7.1%) for NASH with significant fibrosis. Conclusions: By applying a guidelines-compliant algorithm, many patients with T2D were referred for hepatological assessment and liver biopsy. Further studies are necessary to refine non-invasive algorithms.

Original languageEnglish
Article number108882
JournalDiabetes Research and Clinical Practice
Publication statusPublished - Jul 2021


  • Hepatocellular carcinoma
  • Liver biopsy
  • Liver fibrosis
  • Non-alcoholic fatty liver disease
  • Non-alcoholic steatohepatitis
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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