medwireNews: Physicians feel that nonalcoholic fatty liver disease (NAFLD) is sidelined in type 2 diabetes management and should be formally incorporated into routine primary care pathways, say Australian researchers.
Elizabeth Powell (The University of Queensland, Brisbane) and colleagues conducted four focus groups with 24 healthcare professionals, comprising nine general practitioners, seven endocrinologists or endocrine advanced trainees, and three diabetes educators.
These participants identified “a gap in clinical practice” for a structured pathway for the identification and management of NAFLD in people with type 2 diabetes, the team reports in Diabetic Medicine.
The healthcare professionals felt that NAFLD was almost certainly very common in their patients with type 2 diabetes, to the point that identifying and treating it “would result in an overwhelming burden on health services in the absence of a structured pathway,” say the researchers.
Moreover, the participants were unsure of the appropriate assessment for NAFLD, knew that long-term consequences of NAFLD were rare and that its diagnosis would not alter diabetes management, and were limited in their time and resource, leading them to deprioritize NAFLD.
The researchers stress, however, that despite the relatively low risk for serious adverse outcomes, the “failure to recognise and risk stratify NAFLD may lead to future presentation with advanced fibrosis or [hepatocellular carcinoma], and reduced availability and cost-effectiveness of therapies.”
And they add that despite a general feeling of futility about investigating for NAFLD, the “participants acknowledged that patient awareness and understanding of liver disease and cancer risk was important to motivate lifestyle changes.”
In common with studies from other countries, the Australian healthcare practitioners tended to be unaware of existing local sources of information about NAFLD. Powell and team therefore believe “that implementation of a NAFLD pathway will require concurrent delivery of targeted education to facilitate uptake of relevant guidelines and tools.”
The researchers say that all their study participants supported the creation of an NAFLD pathway, and believed that it would fit well in the context of the increasing focus on the prevention of complications.
“Recent literature also supports the shift away from ‘disease silos’ towards holistic models of care for multi-system diseases like NAFLD,” they add.
The team concludes: “By focusing on comorbidity prevention and integrating NAFLD as a diabetes complication to be addressed during established cycles of care, many barriers to implementing a NAFLD pathway in primary care could be overcome.”
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