Diabetes Mellitus and Non-Alcoholic Fatty Liver Disease: Diagnosis and Treatment / 임상당뇨병

ABSTRACT

Stroke is one of the major complications of diabetes and increases morbidity and mortality. Hyperglycemia confers increased risk of stroke occurrence. Furthermore, cardiometabolic risk factors such as hypertension and dyslipidemia frequently coexist in patients with diabetes and increase the risk of stroke. Some recent cardiovascular outcome trials of newer anti-diabetic medications have shown beneficial effects on cardiovascular complications. Prevention and improving outcomes of stroke in patients with diabetes requires proper management of hyperglycemia and additional risk factors. This review is an evidence-based approach to the epidemiology, glycemic control, effects of anti-diabetic medications on stoke, and risk factor management for prevention and improving outcomes of stroke for patients with diabetes.The prevalence of non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of metabolic syndrome, is rapidly increasing in Korean populations and is estimated to reach 39% among Korean adults. NAFLD is one of the strongest risk factors of type 2 diabetes mellitus (T2DM), and the presence of NAFLD in T2DM patients is associated with a worse natural course of diabetic complications. The gold standard for diagnosing NAFLD is liver biopsy, which involves sampling error, high cost, and other disadvantages related to its invasive nature. We summarize non-invasive diagnostic NAFLD algorithms including biomarkers and four major imaging tools (ultrasonography, computed tomography, magnetic resonance imaging, and liver FibroScanⓇ) for diagnosing NAFLD including hepatic fibrosis. To prevent NASH (nonalcoholic steatohepatitis) or liver fibrosis, a combination of lifestyle modification with a low caloric diet and exercise, anti-diabetic agents, and non-anti-diabetic agents should be applied.