Paula Macedo, Professor of Phisiology at NMS and researcher at CEDOC, explains what is the relation between the different stages of NAFLD – Non-Alcoholic Fatty Liver Disease – and the evolution of type 2 Diabetes as well as its relationship with other comorbidities, namely Diabetic Nephropathy and cardiovascular diseases.
Although the impact of NADLD on patients with type 2 Diabetes is not yet clear, an APDP – Associação Protectora dos Diabéticos de Portugal - study is underway to determine the relationship between these two diseases. The liver is an organ that has decisive functions when it comes to the regulation of glucose homeostasis. One of them is the storage of glucose that, when fasting, is released so that it can serve as an energetic substrate for our brain. In contrast, the liver is a regulator of insulin levels, which is critical for capturing glucose into cells. So when it comes to healthy people, these physiological mechanisms work in a balanced way. Unhealthy people, that is, when they have non-alcoholic fatty liver, this creates a resistance to hepatic insulin, increasing the release of glucose, leading to an increase in circulating glucose levels to undesirable levels.
The main challenges caused by this relationship are, firstly, the diagnosis - liver biopsy - of the NAFLD itself as well as its complications - such as inflammation, fibrosis, infiltrations, cancer or cirrhosis. And secondly, by the appropriateness of the therapy to the different phases of NAFLD. It should be noted that there are some studies that show that a prolonged hypocaloric diet can have beneficial effects on type 2 diabetes, causing the NAFLD to go into remission. In the study sponsored by the APDP, hepatic steatosis is being evaluated in patients with type 2 diabetes, in an attempt to associate the different stages of the disease with the treatment applied, the progression of this type of diabetes and the control of the disease. The results of this study are expected to be obtained by the end of 2020.