ArticleJHEP reports : innovation in hepatology2021
Embedding assessment of liver fibrosis into routine diabetic review in primary care.
Article in JHEP reports : innovation in hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- Artificial intelligence for pathologic myopia classification based on the META-PM system: a systematic review and meta-analysis.Frontiers in physiology · 2026Pooled it
- AGA Clinical Practice Update: Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Lean Individuals: Expert Review.Gastroenterology · 2022Guideline
- Two-step care pathways for advanced MASLD in primary and hospital care: A multicenter study.Hepatology communications · 2026Article
- Dual target, dual benefit: real-world effects of SGLT2 inhibitors and GLP-1 receptor agonists on the FIB-4 score in people with type 2 diabetes mellitus.Hormones (Athens, Greece) · 2026Review
- Using the enhanced liver fibrosis test to identify disease in at-risk populations.BMJ open gastroenterology · 2026Article
- Diabetes and obesity reduce FIB-4 accuracy in MASLD referral pathways.JHEP reports : innovation in hepatology · 2026Article
- Care Pathways for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-The-Art Review.Liver international : official journal of the International Association for the Study of the Liver · 2026Review
- Metabolic dysfunction-associated steatotic liver disease management in Saudi Arabia: A modified Delphi-based adaptation of international standards.Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association · 2026Article
- A liver function test pathway significantly increases the early detection of chronic liver disease and cirrhosis.Hepatology communications · 2026Article
- Diabetes and liver cirrhosis: shared pathways and clinical implications - a narrative review.Annals of medicine and surgery (2012) · 2025Review
- Screening to identify people with type 2 diabetes at risk of liver cancer in primary care: a randomised controlled trial protocol.BMJ open · 2025Article
- Metabolic Dysfunction-associated Steatotic Liver Disease and Type 2 Diabetes: A Deadly Synergy.TouchREVIEWS in endocrinology · 2024Article
- Review
- Early screening for chronic liver disease: impact of a FIB-4 first integrated care pathway to identify patients with significant fibrosis.Scientific reports · 2024Article
- Population screening for cirrhosis.Hepatology communications · 2024Review
- Automated Fibrosis-4 Index: Simplifying Non-Alcoholic Fatty Liver Disease for Diabetologists.Medicina (Kaunas, Lithuania) · 2024Article
- Accuracy of a sequential algorithm based on FIB-4 and ELF to identify high-risk advanced liver fibrosis at the primary care level.Internal and emergency medicine · 2024Article
- Article
- Roles of Radiological Tests in Clinical Trials and the Clinical Management of Nonalcoholic Fatty Liver Disease.Clinics in liver disease · 2023Review
- Expert Panel Consensus on Clinical Assertion Statements Describing Noninvasive Tools for Diagnosing Nonalcoholic Steatohepatitis.Journal of clinical gastroenterology · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND &
aimsIndividuals 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.
methodsAll 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.
resultsA 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]
conclusionsIncorporating 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. LAY SUMMARY: 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.