Co-hosts Ken Cusi and Roger Green are joined by Diana Barb and Jay Shubrook in a discussion around what tools are available today for fighting fatty liver disease. This is an entirely apt and applicable conversation that drills to the core of how important the role of frontline treaters is in putting a dent in an unraveling public health crisis.
Among a plethora of invaluable and practical insights, the following major themes emerge:
12:56 Primary Care Perspective: Why Screen Patients for Fatty Liver Disease?
Jay notes that when identified early, NAFLD and NASH are largely preventable and wholly treatable. Nevertheless, public awareness is low and patients are not typically presenting with questions around these conditions. He goes on to underscore the importance of adopting a leading and proactive role in screening, particularly for those with targeted risk factors like obesity, Type-2 diabetes and features of metabolic syndrome. When asked what proportion of his practice meets this criteria, Jay offers a sobering response: approximately half or two-thirds. Diana comments on the value of having a simple frontline screening tool, FIB-4, and elaborates in further detail on the goal of identifying those at most risk of fibrosis.
21:20 The Interplay of Endocrinology and Hepatology
Ken comments on the evolving relationship and dynamism between hepatologists working with endocrinologists to combat the swelling burden of NAFLD and NASH. His main note considers the ability to prescribe pioglitazone and GLP-1s as an adjunct to lifestyle interventions.
23:26 FIB-4 as a Predictor of Major Adverse Cardiovascular Events
Roger notes part of the utility of FIB-4 is its ability to identify patients with NAFLD at highest risk of cardiovascular events. Jay goes on to relate his on-ground experience of working with FIB-4 and assessing results to inform subsequent action.
25:11 Therapeutic Options: Now and the Future
Jay adds semaglutide to Ken’s note of pioglitazone and GLP-1s as therapeutic options available today useful to combat Fatty Liver disease. Jay suggests that he might continue using these drugs even after the approval of a NASH-specific drug. He states that simply, “we need to use the tools we have and we need to get comfortable with them.”
29:00 Patient Support and Lifestyle Management
The group considers how best to help patients implement and maintain healthy lifestyle habits. One important note that emerges is the need to adjust the barometer for which typically defines successful weight loss. Ken remarks that a 5% weight loss is a major success associated with less cardiovascular disease and diabetes.
39:54 Role of Bariatric Surgery
Roger asks for what considerations and motivations precede recommending bariatric surgery. Diana and Ken diver deeper into this evaluation process, noting both the challenges and efficacy of the treatment option not only for NASH, but also diabetes.
As the session winds down, the panelists return to analyzing the pharmacotherapy landscape before parting with practical tips for the listeners. If you enjoy the episode, have questions or interest around its contents, we kindly ask that you write us your questions.
This podcast series and all episodes are produced under a non-restricted grant from Novo Nordisk. Novo Nordisk has neither influenced nor reviewed the contents of this podcast in any way. This content represents the views of the speakers and does not necessarily represent the views of Novo Nordisk. The content herein is for educational purposes only and should not be taken as medical advice.
