■患有2型糖尿病(T2DM)的个体具有发生非酒精性脂肪性肝病(NAFLD)和晚期纤维化/肝硬化的高风险。在初级保健中筛查T2DM和正常肝酶的NAFLD患者仍然存在争议。我们的目标是开发和评估整合两层（Fib-4然后瞬时弹性成像[TE]）肝纤维化评估的初级护理途径，不管病因如何，纳入所有T2DM患者的常规年度审查。
在2018年4月至2019年9月期间在英格兰东北部的2个初级保健实践中接受年度审查的所有年龄>35岁的T2DM患者（n=467）通过电子病历要求Fib-4。那些Fib-4评分高于“高灵敏度”阈值（>1.3≤65年和>2.0>65年）的患者接受TE，如果肝脏硬度测量（LSM）>8kPa，则在二级护理中进行审查。确定患有晚期疾病的患者数量，服务吸收，并评估了晚期疾病的预测因子。
■共有85/467（18.5％）的患者升高了Fib-4；27/467（5.8％）由于虚弱或已知的肝硬化而被排除。总共58/467（12.2%）被转诊为TE。58人中有25人（43.1％）的LSM>8kPa，13/58（22.4％）的LSM>15kPa；4/58（6.7％）未参加，5/58（9.3％）的读数无效。440名患者中有20名（4.5％）在专家审查后被发现患有晚期肝病，与之前通过标准治疗确定的3例患者相比(比值比[OR]6.71[2.0-22.7]p=0.0022).酒精（OR1.05[1.02-1.08]p=0.001）和BMI（OR1.09[1.01-1.17]p=0.021）是晚期疾病的预测因子，特别是饮酒>14/21单位/周（p<0.0001）。
■将2级肝纤维化评估纳入初级保健常规年度糖尿病综述，可显著提高T2DM患者对晚期肝病的识别。
■2型糖尿病患者发生非酒精性脂肪性肝病和更严重并发症的风险增加。这项研究着眼于在初级保健常规进行的年度糖尿病审查中引入晚期肝病的筛查;我们发现，与当前的标准护理相比，通过这种途径被确定为患有严重肝病的人明显更多。
UNASSIGNED: Individuals with type 2 diabetes (T2DM) are at high risk of developing non-alcoholic fatty liver disease (NAFLD) and advanced fibrosis/cirrhosis. Screening patients with T2DM and normal liver enzymes for NAFLD in primary care remains contentious. Our aim was to develop and assess a primary care pathway integrating two-tier (Fib-4 then transient elastography [TE]) liver fibrosis assessment, irrespective of aetiology, into routine annual
review of all patients with T2DM.
UNASSIGNED: All patients aged >35 years with T2DM attending annual
review at 2 primary care practices in North East England between April 2018 and September 2019 (n = 467) had Fib-4 requested via the electronic patient record. Those with a Fib-4 score above the \'high-sensitivity\' threshold (>1.3 for ≤65 years and >2.0 for >65 years) underwent TE and were reviewed in secondary care if the liver stiffness measurement (LSM) was >8 kPa. The number of patients identified with advanced disease, service uptake, and predictors of advanced disease were assessed.
UNASSIGNED: A total of 85/467 (18.5%) patients had raised Fib-4; 27/467(5.8%) were excluded as a result of frailty or known cirrhosis. A total of 58/467 (12.2%) were referred for TE. Twenty-five of 58 (43.1%) had an LSM of >8 kPa and 13/58 (22.4%) had an LSM >15 kPa; 4/58 (6.7%) did not attend and 5/58 (9.3%) had an invalid reading. Twenty of 440 (4.5%) patients were found to have advanced liver disease following specialist
review, compared to 3 patients previously identified through standard care (odds ratio [OR] 6.71 [2.0-22.7] p = 0.0022). Alcohol (OR 1.05 [1.02-1.08] p = 0.001) and BMI (OR 1.09 [1.01-1.17] p = 0.021) were predictors of advanced disease, particularly drinking >14/21 units/week (p <0.0001).
UNASSIGNED: Incorporating 2-tier assessment of liver fibrosis into routine annual diabetes
review in primary care significantly improves identification of advanced liver disease in patients with T2DM.
UNASSIGNED: People with type 2 diabetes are at increased risk of developing non-alcoholic fatty liver disease and developing more significant complications. This study looks at introducing screening for advanced liver disease into the annual diabetes reviews performed routinely in primary care; we found that significantly more people were identified as having significant liver disease through this pathway than with current standard care.
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