CHANDIGARH: A landmark study has identified a “fourth complication” of Type 2 diabetes hiding in plain sight, revealing that lakhs of patients are progressing toward life-threatening liver failure without showing a single outward symptom.The DiaFib-Liver Study, published in The Lancet, is the largest real-world survey of its kind conducted in a developing nation. It warns that for the global diabetic population – now exceeding 50 crore – the liver is under as much threat as the heart, eyes, and kidneys.The research, which screened 9,202 adults across 27 hospitals and clinics in India, uncovered a startling trajectory of “silent” disease: One in four patients suffers from clinically significant liver scarring (fibrosis). One in seven has progressed to advanced stages of the disease. One in 20 has already reached the threshold of probable cirrhosis. “Diabetes is now the mother of modern liver disease,” said Dr Ashu Rastogi, principal investigator of the study from the PGI.Dr Rastogi noted a dramatic shift in clinical wards, where diabetes and obesity have overtaken Hepatitis B and C as the primary drivers of liver transplants. Liver damage is not confined to people who are overweight, the study has found, pointing out that significant scarring can also occur in lean individuals and those without visible liver fat. The damage, researchers said, is driven by hepatic insulin resistance, a condition in which fat accumulation causes the liver to stop responding to insulin. This process triggers chronic inflammation and can eventually lead to permanent scarring.
1 In 4 Patients Suffers From Liver Scarring
While obesity and high cholesterol remain major risk factors, the study challenges the perception that liver disease affects only those who are overweight. Researchers identified a phenomenon termed “burntout” liver disease, in which fat gradually disappears as scarring worsens, leaving the liver shrunken and poorly functioning. In such “fatlight” cases, age and prolonged exposure to high blood sugar over years emerged as the strongest predictors of liver damage.Because liver disease often produces few symptoms until it reaches an advanced stage, researchers have called for changes in screening protocols. They said routine ultrasounds may not be sufficient for early detection and recommended the use of tools such as the FIB-4 score, a calculation based on standard blood tests, and FibroScan imaging to identify atrisk patients before damage becomes irreversible.Despite the seriousness of the findings, researchers noted that liver damage can be reversed through lifestyle changes. The study observed that a 5% reduction in body weight could reverse scarring in up to 60% of patients, while a 10% weight reduction could halt advanced fibrosis in nearly half of cases.The findings carry wider significance as global Type 2 diabetes cases are projected to hit 78 crore by 2045. India currently serves as the epicentre of this crisis, with 10.1 crore diabetics and another 13.6 crore individuals classified as pre-diabetic. By integrating liver checks into national diabetes programmes, health officials believe they can pivot from reactive, costly transplants to proactive prevention, stopping a healthcare crisis in its tracks.
