In the past decade or so, our attempts to define the "earliest” events in Type 2 diabetes (T2DM) have moved increasingly earlier. We’re considering even the years before what we now consider to be the “pre-diabetes” stage—that is, years considerably before there are any clinical signs or symptoms of disease.
Fatty liver disease is the most common cause of chronic liver disease in North America[1] and is becoming one of the top reasons for liver transplantation. Fatty liver causes inflammation that can lead to fibrosis, cirrhosis, and hepatocellular carcinoma. The physiologic relationship between type 2 diabetes mellitus and fatty liver disease is complex and multifactorial.
A 52-year-old Caucasian man was diagnosed with type 2 diabetes (T2DM) eight years ago and has been under your care for the past three years. His current treatment regimen includes glargine (50 units daily), metformin (1,000 mg b.i.d.), and glimepiride (2 mg daily), as well as lisinoprol (20 mg daily), and atorvastatin (20 mg daily).
Recent blood tests came back normal for lipid levels as well as renal and liver function, but showed an HbA1c level of 8.0%.