Recently, the American Diabetes Association (ADA) emphasized the high risk of non-alcoholic fatty liver disease (NAFLD) – now referred to as metabolic dysfunction-associated steatotic liver disease (MASLD). – among the 1 in 10 Americans living with type 2 diabetes by calling for more screening and early detection of the disease.
Up to 70% of people currently living with type 2 diabetes are estimated to have liver disease and only 5% of them are diagnosed. The diagnosis gap is staggering.
Early diagnosis is crucial because liver disease—which is typically asymptomatic in early stages—can lead to cancer, cirrhosis, as well as increase the risk of cardiovascular disease and death. The reality is 1 in 4 people are walking around with early-stage fatty liver disease and are completely unaware. Unless they’re screened, they may never know until it’s too late.
The ADA isn’t alone. In fact, it’s now the third respected global clinical organization to publish guidelines for earlier liver disease screening, in the past 6 months. It’s become a deafening cry for change as the ADA stacks its recommendations on top of similar guidance from the American Association for the Study of Liver Diseases (AASLD) & the United Kingdom’s National Institute for Health and Care Excellence (NICE). There is now an overdue unprecedented focus on MASLD given its meteoric rise in prevalence, reaching epidemic proportions.
Theoretically, we stand on the brink of a transformative shift in liver disease screening that is poised to reshape medical practices and patient outcomes for the better. But, is America ready to heed the call? Is the clinical community prepared to deal with a resulting tidal wave of screenings?
Given the substantial economic burden MASLD places on healthcare systems worldwide, we’d be foolish not to. Then, considering the high death rates attributed to liver disease, we’d be even more foolish, arguably immoral, not to act. There are 5 key challenges that must be addressed to successfully lessen, if not close the diagnosis gap, and ultimately save lives.
1. Increase public awareness
We need to increase public education and awareness about the primary risk factors for MASLD, which include Type 2 diabetes, metabolic syndrome, obesity and/or being over age 50. People also need to know that liver damage resulting from a chronically unhealthy diet can often be reversed by early diagnosis and intervention. That’s exactly why people who are at risk need to talk to their doctors about regular screening. With earlier detection, fatty liver disease can often be reversed. There’s hope.
2. Address health disparities
Marginalized communities often bear a higher burden of liver disease, as a result of socioeconomic disparities. As a society and an industry, we must increase efforts to improve access to screenings and treatment among populations that are in greatest need. That should include more community-based solutions that meet people where they’re at and surround them with support to help remove barriers they may have to accessing the quality care and the proper nutrition they need and deserve.
3. Adopt noninvasive tests as the new standard of care
Recent advances in technology have made screening for liver disease, particularly MASLD, more accessible, painless and convenient. While liver biopsy has long been a standard diagnostic tool for liver disease, use of biopsies is not scalable against today’s growing need because the procedures are expensive, invasive, and come with higher risk to the patient—which can include bleeding, infection, discomfort, injury to nearby organs and even more severe complications.
Alternatively, today’s non-invasive diagnostic methods, such as VCTE, can directly measure physical properties of liver stiffness and liver fat within 10 minutes, creating a safe and efficient way to diagnose and monitor liver disease. Non-invasive screenings are also a more accessible means for healthcare providers to monitor the positive effects of patient lifestyle changes over time, allowing them to reinforce behaviors that lead to improved liver health in regular check-ups and follow-up appointments with their patients.
4. Expand screening earlier in the care pathway
Until recently, the majority of liver disease screening was done by specialists—mainly gastroenterologists and hepatologists. Significant progress is being made to bring screening to primary care settings, but the current pace of change is not yet on par to meet the growing prevalence of the disease. As a result, our ability to identify those at risk of adverse outcomes and connect them with preventative care and treatment remains inadequate. It’s critical that we accelerate the rate of adoption of liver disease screening in primary care settings.
Any practitioner caring for people at risk for MASLD—which includes both endocrinologists and primary care physicians—should follow the guidance for noninvasive risk stratification with VCTE™ technology.
Screening earlier in the care pathway allows us to not only catch disease earlier and potentially improve outcomes, but it also yields cost savings and scheduling efficiencies compared to the costs of referring someone for secondary or specialist care testing.
5. Develop better disease management solutions To manage the growing wave of screening needs, clinicians need support by way of more robust, connected and effective disease management platforms. We must build a future where data from enriched and connected exams help providers deliver simpler, faster and better patient care. A platform that can flag at-risk individuals within your patient population, help you identify what intervention is recommended for them within industry guidelines, customized reporting and advanced clinical decision support. This type of clinical support will enable clinicians to see more patients and help them make the right decisions, efficiently.
Let’s not wait another day to tackle the hard work that needs to be done to fully reckon with the rising prevalence of liver disease in America. We must prioritize early screening and diagnosis to facilitate timely interventions, prevent the progression to advanced liver disease and, ultimately, help save the lives of 1 in 10 Americans.
Photo: eranicle, Getty Images