Clinical Prevalence and Treatment Standards for Nonalcoholic Fatty Liver Disease Among Diabetic Patients in India - A Physicians’ Survey

Background/Aims: Type 2 diabetes mellitus (T2DM), obesity, and hyperinsulinemia are predisposing factors for nonalcoholic fatty liver disease (NAFLD). The prevalence of NAFLD in Indian subjects with T2DM is reported to range from 12.5% to 87.5%, with studies over the years showing an increasing trend. This study aimed to understand the prevalence patterns, gaps in management, and current treatment options for the management of NAFLD in Indian patients with T2DM. Methods: A 15-question survey form was used to assess physicians’ practice, and attitudes regarding NAFLD in diabetic patients. Each physician provided data for 15 patients with T2DM and underlying NAFLD who were receiving treatment for NAFLD. Results: In all, 271 physicians from 93 cities responded to the survey. According to 80% of the physicians, NAFLD was prevalent in 40%-60% of patients with T2DM. Diabetes with obesity, hypertension, and dyslipidemia was reported to affect the severity of NAFLD in patients with T2DM. Most patients with T2DM and NAFLD were aged 40-60 years, and 94.5% of physicians responded that their glycated hemoglobin (HbA1c) was >7%. Only 36.5% of the physicians reported screening 40%-60% of patients with T2DM for NAFLD, with liver function tests (LFTs) and ultrasonography being the most common approach used by 78.6% of the physicians. Abnormal LFTs and fatty liver on ultrasonography were the criteria for initiating drug therapy. Lifestyle modifications with drug therapy were the most common approach for management, and ursodeoxycholic acid and vitamin E were the main drugs of choice. Only 33.9% of the physicians used LFTs every three months for follow-up of patients with NAFLD. Conclusion: Although NAFLD was observed in 40%-60% of subjects with T2DM, especially those aged 40-60 years, the percentage of patients screened, treated, and followed-up for NAFLD in routine clinical practice continues to remain low.