Management of non-alcoholic fatty liver disease in patients with diabetes mellitus

Non-alcoholic fatty liver disease (NAFLD) is an emerging global epidemic, closely related to obesity, diabetes and metabolic syndrome.Its association with obesity, dyslipidemia, insulin resistance and type 2 diabetes supports the notion that NAFLD is the hepatic manifestation of the metabolic syndrome. NAFLD, nowadays the most common cause of abnormal liver function tests, affects approximately 25% of the general population and includes a wide spectrum of liver disease, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) with the possibility of progression to cirrhosis and hepatocellular carcinoma (HCC).The aim of this paper is to describe the therapeutic strategies contributing to the management of fatty liver disease in type 2 diabetes patients and the pathways these drugs interfere with to stop the development or even induce the regression of the liver disease.The progression of NAFLD to its various stages needs to be stopped. Besides insulin resistance, which is the main target in the therapeutic strategy, the ongoing studies provide new evidence on mechanisms that need to be interfered with to help deal with the metabolic syndrome components and improve the cardiovascular disease (CVD) risk factors.Dietary changes and other lifestyle modification measures form the primary line of treatment. New molecules are currently developed for the management of NAFLD that act on various therapeutic targets, besides the anti-diabetic treatment. Metabolic surgery remains the last option of NAFLD therapy, as it is highly invasive, even though it provides good results.