Journal of Endocrinological Investigation

, Volume 41, Issue 5, pp 509–521 | Cite as

NAFLD/NASH in patients with type 2 diabetes and related treatment options

  • M. G. Radaelli
  • F. Martucci
  • S. Perra
  • S. Accornero
  • G. Castoldi
  • G. Lattuada
  • G. Manzoni
  • G. Perseghin


Type 2 diabetes may reduce life expectancy and patients’ quality of life due to its micro- and macro-vascular complications and to the higher risk of several types of cancer. An emerging important factor is represented by the hepatic involvement; it is recognized that excessive hepatic fat accumulation represents a typical feature of diabetic patients and that it also plays an important pathogenic role. It is now evident that non-alcoholic fatty liver disease (NAFLD), generally perceived as a benign condition, may have on the contrary an important deleterious impact for diabetic patients increasing the risk to develop cardiovascular complications but also serious hepatic diseases, in particular non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma. Lifestyle intervention, bariatric surgery and several drug therapies have now accumulated evidence of efficacy in treating NASH. On the other hand, their durability and safety in the long-term is yet to be proven and their use may be sometimes associated with side effects or higher risk of adverse events limiting the regular administration or contraindicating it. Professional health care providers, building awareness about the importance of these hepatic complications, should put more efforts in primary prevention using a behavioral therapy needing a multidisciplinary approach, in secondary prevention applying on a regular basis in the clinical setting available predictive algorithms to identify the patients at higher cardiovascular and hepatologic risk, and in tertiary prevention treating, when not contraindicated, the diabetic patients preferentially with drugs with proven benefit on NAFLD/NASH.


Hepatocellular ballooning Fibrosis Cirrhosis Hepatocellular carcinoma NAFLD score Fatty liver index (FLI) 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to the manuscript.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent



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Copyright information

© Italian Society of Endocrinology (SIE) 2017

Authors and Affiliations

  • M. G. Radaelli
    • 1
  • F. Martucci
    • 1
  • S. Perra
    • 1
  • S. Accornero
    • 1
  • G. Castoldi
    • 2
  • G. Lattuada
    • 1
  • G. Manzoni
    • 1
  • G. Perseghin
    • 1
    • 2
  1. 1.Dipartimento di Medicina e RiabilitazionePoliclinico di MonzaMonzaItaly
  2. 2.Dipartimento di Medicina e ChirurgiaUniversità degli Studi di Milano BicoccaMilanItaly

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