The 2019 Standards of Medical Care in Diabetes issued by the American Diabetes Association recommend that patients with Type 2 diabetes or pre-diabetes and elevated liver enzymes or fatty liver on ultrasound should be screened for the presence of liver disease.
Value of screening and early detection
A growing number of physicians – particularly at FQHCs which treat a significant number of minority patients -- are acquiring the noninvasive technique of vibration-controlled transient elastography (VCTE): an ultrasound-based technology that is now a tool of choice for detecting and monitoring liver disease.
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Recent studies show that VCTE is a non-invasive and quick way for clinicians to quantify the stiffness of liver tissue and estimate liver fat at the point of care. VCTE-defined hepatic fibrosis is associated with multiple cardiovascular risk factors, including obesity, metabolic syndrome, diabetes, hypertension and high-density lipoprotein cholesterol.
A recent retrospective cohort study also determined that VCTE technology correlates well with the presence of advanced liver fibrosis and clinically significant portal hypertension in patients with hepatitis C virus (HCV) infection. This technology can be used to measure liver stiffness either before or after anti-viral treatment, making it a critical tool in determining the development of HCC, decompensated liver disease and death. Patients with NAFLD also have an increased risk of coronary artery disease compared to the general population.
Fortunately, VCTE is covered by Medicare, Medicaid and many insurance plans, and can be operated by a medical assistant for immediate interpretation by a healthcare professional.
Because NAFLD and NASH are so tightly intertwined with obesity, diabetes and lifestyle, a “whole person” approach to patient engagement is necessary to support behavioral changes that will result in better outcomes across the co-morbid conditions affecting the individual patient.
Diet and exercise interventions can be effective at reversing steatosis and modifying cardio-metabolic risk factors related to metabolic syndrome. For many patients, a 3% reduction in body weight has been associated with reversal of steatosis and a reduction of greater than 7% may resolve NASH in many patients. Disease progression is typically slow, and patients can be managed well by primary care physicians.
Choosing a VCTE partner
Healthcare leaders interested in adopting VCTE technology should look for tools that produce numeric measurements—not images—for simplified interpretation and consistency of measurement. This enables clinicians to monitor changes in liver tissue over time. Experts anticipate that rapid tools that provide consistent liver measurements will be performed as a routine part of patient management.
Given health and demographic trends across the nation, more health care professionals are heeding the urgent call to implement cost-effective and efficient technology designed to provide an accurate, cohesive and first-line approach to assessing and managing patients at risk of liver damage—and addressing health disparities among minority groups.
About the author: Jon Gingrich is the CEO of Echosens North America.
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