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S3-E1.2 - NAFLD Prevalence and Type 2 Diabetes in an Endocrinology Clinic: The Need for Screening and Vigilance

S1-E1.2 – NAFLD Prevalence and Type 2 Diabetes in an Endocrinology Clinic: The Need for Screening and Vigilance

Fatty Liver Researcher and endocrinology key opinion leader Ken Cusi discusses the high levels of NAFLD prevalence and fibrosis among Type 2 Diabetes Mellitus patients and the value of early screening, particularly in endocrinology clinics, where the percent of patients with NAFLD and NASH fibrosis is double what we find in primary care.

NAFLD prevalence is an increasing topic of conversation and concern. Some refer to it as “the new pandemic.” The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide is a new podcast dedicated to focusing on prevalence, severity and downstream health implications for patients with Type 2 Diabetes and other metabolic diseases. This conversation centers around a segment of the first episode in the series that addressed the unique place for endocrinology practices in screening and identifying Fatty Liver patients.

NAFLD Prevalence and Type 2 Diabetes in an Endocrinology Clinic: The Need for Screening and Vigilance

The first study he mentions is an analysis of NHANES data published in Obesity, lead author Dr. Diana Barb. Dr. Barb and colleagues looked at over 800 patients and reported that simply being overweight with concomitant T2D doubles the probability of NASH and that as BMI rises from 30 to 35 to 40, most people will have steatosis and most of these will have NASH.

This episode starts with Fatty Liver Researcher and endocrinology key opinion leader Ken Cusi praising Stephen Harrison’s prospective NAFLD prevalence study and noting how closely Type 2 Diabetes Mellitus (T2D) and Fatty Liver disease are linked. Ken starts by pointing out that that estimates of NAFLD Prevalence among patients with T2D run as high as 70%. He shares the two primary foci of his research and writing to date: how to use existing anti-diabetes medications to treat Fatty Liver disease alongside T2D, and doing a better job of finding the people who we need to treat, much as we look for kidney disease, eye disease and neuropathic disease.

Ken goes on to note that the rate of NASH in people with T2D and other metabolic conditions might run as high as 46-50%. Many of these patients are obese and have poorly controlled T2D. He goes on to site his second study, conducted in clinics at the University of Florida with over 600 patients, which assessed T2D patients for NAFLD and NASH using VCTE (FibroScan) measurements. This study showed fibrosis in 20-21% of patients studied and 15% with F2 NASH or higher. More important, it showed that the incidence of steatosis and fibrosis was twice as high in endocrinology clinics than it was in primary care settings. These patients have likely had NASH for a longer period of time, which means greater potential for organ damage.

Stephen Harrison asks Ken is there is a correlation between how long the patient has been diabetic and/or level of HbA1c. Ken reports that there are no demonstrated correlations with either variable.

As the session ends, Kay Pepin asks whether there is something simple we can do to screen patients effectively in a world where 15% of diabetics or more have fibrosis and are on the path to potentially devastating disease. Ken notes that initially screening all T2D patients with a FIB-4 test will do a fairly good job of negative prediction and that patients with a high enough level of FIB-4 can be screened further. As guidelines from the various medical societies begin to promote Fatty Liver screening guidelines and multi-specialty clinical care pathways, the idea of an initial FIB-4 screen comes to the fore.

S2-5 – Key Insights from the American Diabetes Association 83rd Scientific Sessions

Ken Cusi and Roger Green are joined by family practice researcher and KOL Eric Johnson and diabetologist and primary care KOL Jay Shubrook in a discussion around exciting news emerging from the ADA 83rd Scientific Sessions meeting. Layering in practical takeaways, the group explores their impressions from the meeting, the utility of FIB-4 as a frontline screening tool, guidelines and recommendations, therapeutic options both now and in the imminent future, and lastly the new nomenclature rollout for Fatty Liver disease.

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S2-E3 – Why Clinical Care Pathways Matter

In this episode of the Rising Tide series, co-hosts Ken Cusi and Roger Green are joined by KOL in public health, Jeff Lazarus, and physician and associate professor of internal medicine, Jeff Budd. The panelists focus on why clinical care pathways matter and drive the message that primary care plays an integral role in fighting fatty liver.

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S2-E2 – A Deeper Dive Into Fatty Liver, NAFLD, and NASH

In this episode of the Rising Tide series for frontline professionals, the patients themselves and caregivers, co-hosts Ken Cusi and Roger Green are joined by KOL in hepatology, Manal Abdelmalek and KOL in endocrinology, Scott Isaacs for a deeper dive into Fatty Liver, NAFLD and NASH. The group discusses: morbidities and mortalities related to fatty liver disease, paradigm-shifting data, screening for risk stratification, pediatric and adolescent populations, unique key takeaways and much more.

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S2-1 – Combating Swelling NAFLD and NASH Prevalence: Drugs, Diagnostics and Guidelines for the Frontline

In the Season 2 debut of the Rising Tide series for healthcare professionals who treat diabetic patients, the patients themselves and their caregivers, co-hosts Ken Cusi and Roger Green are joined by Mazen Noureddin to talk about prevalence and taking action on the frontlines today. The trio explore emerging NASH drugs, noninvasive testing and guidelines for treating different stages of disease progression.

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S1-E2 — What’s Behind The New AACE Fatty Liver Guidelines?

Drs. Mary Rinella, Zobair Younossi and Diana Barb join co-hosts Dr. Ken Cusi and Roger Green to explore the new AACE Fatty Liver guidelines. Learn about the epidemiology and research behind the guidelines and what they recommend for endocrinologists, primary care physicians and allied health professionals when screening, diagnosing and managing Type 2 Diabetes patients for Fatty Liver disease.

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S1-E1.1 – Fatty Liver Prevalence May Be Higher Than Previously Thought, Especially Among Type 2 Diabetes Patients

Hepatology Researcher and Key Opinion Leader Stephen Harrison discussed results of his 2021 publication in the Journal of Hepatology that reported, in a prospective random sample of 835 people with a median age of 55, NAFLD prevalence as being 37%, NASH as being 14% and advanced fibrosis as being 6% in a random asymptomatic patients. Among patient with Type 2 Diabetes, NAFLD prevalence was 70% and NASH was 35%.

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S1-E1 – New Podcast: Growing NAFLD-Diabetes Dual Prevalence Increases CVD Risk for Diabetics

In this Premier episode of The NASH Tsunami in Diabetes: Getting Ahead of the Rising Tide, key opinion leaders Doctors Stephen Harrison, Kathleen Corey and Kay Pepin join co-hosts Dr. Ken Cusi and Roger Green to discuss key issues related to the NAFLD-Diabetes Link, NAFLD-Diabetes Dual Prevalence: very high NAFLD and NASH prevalence in diabetics leads to increased CVD risk and other metabolic issues.

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