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LFTs 'inadequate' for diabetes patients

Liver function tests are an 'inadequate' screening tool for serious liver disease in older people with type 2 diabetes, research suggests.

The study that looked at LFTs in more than 900 randomly selected people with type 2 diabetes, showed the tests missed most cases of fibrosis predicted by raised hyaluronic acid levels.

The study found the prevalence of liver disease in diabetes patients may actually be far lower than previously reported.

Cirrhosis was identified by ultrasound in four participants (0.4%), ten (1%) had evidence of portal hypertension (shown by platelet count/spleen diameter ratio< 909), and two (0.2%) had hepatocellular carcinoma, the Edinburgh study showed.

In all, 53 participants had evidence of hepatic fibrosis defined with hyaluronic acid levels less than 100ng/ml – an incidence of 5.7%. Yet LFT results would have missed most cases of fibrosis in this group of 61–76 year olds, the researchers report in QJM.

The cases of advanced liver disease were unexpectedly low, the researchers said, but one explanation could be the use of drugs such as metformin may halt the progression of non-alcoholic fatty liver disease.

The researchers concluded: ‘There are challenges in detecting advancing liver disease, and current screening methods using conventional LFTs are almost certainly inadequate.'

'More work is needed to work out how to best identify at risk patients', they added.

Q J Med, published online 7 December 2011

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