Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus
Aim. A current overview of non-pharmacological and drug-based approaches to non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (T2D).Key points. NAFLD is associated with an increased cardiovascular risk (due to association with “metabolic syndrome”) and the risks of liv...
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| Format: | Article |
| Language: | Russian |
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Gastro LLC
2021-06-01
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| Series: | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
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| Online Access: | https://www.gastro-j.ru/jour/article/view/543 |
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| author | A. E. Bagriy A. D. Zubov M. V. Khomenko E. S. Mikhailichenko E. A. Pylaeva N. A. Khaustova E. V. Bryukhovetskaya |
| author_facet | A. E. Bagriy A. D. Zubov M. V. Khomenko E. S. Mikhailichenko E. A. Pylaeva N. A. Khaustova E. V. Bryukhovetskaya |
| author_sort | A. E. Bagriy |
| collection | DOAJ |
| description | Aim. A current overview of non-pharmacological and drug-based approaches to non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (T2D).Key points. NAFLD is associated with an increased cardiovascular risk (due to association with “metabolic syndrome”) and the risks of liver cirrhosis and hepatocellular carcinoma. Macro- and microvascular complications in T2D comorbidity entail a higher overall mortality. A conjunction of lifestyle change and rational medication strategies to reach the target levels of glycosylated haemoglobin, low-density lipoprotein cholesterol, systolic and diastolic blood pressure is key in management of such patients. A body weight loss by 5–7 % or more (through caloric restriction or a bariatric surgery) promotes a marked reduction in liver fat and even reversal of steatohepatitis. Metered exercise exerts this effect even at insignificant weight loss. Minimising alcohol consumption and smoking is critical. A hepatotropic drug therapy is most essential in moderate fibrotic NAFLD. It includes antidiabetic agents (metformin, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors), bile acid preparations (e.g., 24-nor-ursodeoxycholic acid), farnesoid X receptor agonists (obeticholic acid, tropifexor), statins, acetylsalicylic acid. Combinations are superior to individual-drug schemes.Conclusion. The management of combined NAFLD-T2D requires a close inter-specialty involvement from hepatology, gastroenterology, endocrinology and cardiology. This interdisciplinary problem can be tackled through persuasive lifestyle recommendations and choosing rational medication strategies with a proved hepatoprotective efficacy. |
| format | Article |
| id | doaj-art-e0dbed8bb30c442fb21409c24beb2066 |
| institution | Kabale University |
| issn | 1382-4376 2658-6673 |
| language | Russian |
| publishDate | 2021-06-01 |
| publisher | Gastro LLC |
| record_format | Article |
| series | Российский журнал гастроэнтерологии, гепатологии, колопроктологии |
| spelling | doaj-art-e0dbed8bb30c442fb21409c24beb20662025-02-10T16:14:36ZrusGastro LLCРоссийский журнал гастроэнтерологии, гепатологии, колопроктологии1382-43762658-66732021-06-01312142610.22416/1382-4376-2021-31-2-14-26422Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes MellitusA. E. Bagriy0A. D. Zubov1M. V. Khomenko2E. S. Mikhailichenko3E. A. Pylaeva4N. A. Khaustova5E. V. Bryukhovetskaya6Donetsk National Medical UniversityDonetsk National Medical UniversityDonetsk National Medical UniversityDonetsk National Medical UniversityDonetsk National Medical UniversityCentral City Clinical Hospital No. 1Central City Clinical Hospital No. 1Aim. A current overview of non-pharmacological and drug-based approaches to non-alcoholic fatty liver disease (NAFLD) combined with type 2 diabetes mellitus (T2D).Key points. NAFLD is associated with an increased cardiovascular risk (due to association with “metabolic syndrome”) and the risks of liver cirrhosis and hepatocellular carcinoma. Macro- and microvascular complications in T2D comorbidity entail a higher overall mortality. A conjunction of lifestyle change and rational medication strategies to reach the target levels of glycosylated haemoglobin, low-density lipoprotein cholesterol, systolic and diastolic blood pressure is key in management of such patients. A body weight loss by 5–7 % or more (through caloric restriction or a bariatric surgery) promotes a marked reduction in liver fat and even reversal of steatohepatitis. Metered exercise exerts this effect even at insignificant weight loss. Minimising alcohol consumption and smoking is critical. A hepatotropic drug therapy is most essential in moderate fibrotic NAFLD. It includes antidiabetic agents (metformin, thiazolidinediones, glucagon-like peptide-1 receptor agonists, sodium-glucose co-transporter-2 inhibitors), bile acid preparations (e.g., 24-nor-ursodeoxycholic acid), farnesoid X receptor agonists (obeticholic acid, tropifexor), statins, acetylsalicylic acid. Combinations are superior to individual-drug schemes.Conclusion. The management of combined NAFLD-T2D requires a close inter-specialty involvement from hepatology, gastroenterology, endocrinology and cardiology. This interdisciplinary problem can be tackled through persuasive lifestyle recommendations and choosing rational medication strategies with a proved hepatoprotective efficacy.https://www.gastro-j.ru/jour/article/view/543non-alcoholic fatty liver diseasetype 2 diabetes mellitus |
| spellingShingle | A. E. Bagriy A. D. Zubov M. V. Khomenko E. S. Mikhailichenko E. A. Pylaeva N. A. Khaustova E. V. Bryukhovetskaya Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus Российский журнал гастроэнтерологии, гепатологии, колопроктологии non-alcoholic fatty liver disease type 2 diabetes mellitus |
| title | Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus |
| title_full | Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus |
| title_fullStr | Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus |
| title_full_unstemmed | Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus |
| title_short | Patient Management in Non-Alcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus |
| title_sort | patient management in non alcoholic fatty liver disease and type 2 diabetes mellitus |
| topic | non-alcoholic fatty liver disease type 2 diabetes mellitus |
| url | https://www.gastro-j.ru/jour/article/view/543 |
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