Interactive case study: Fatty liver disease and type 2 diabetes

Diabetes & Primary Care’s series of interactive case studies is aimed at GPs, practice nurses and other professionals in primary and community care who would like to broaden their understanding of type 2 diabetes.

The case study created for this issue of the journal covers various aspects relating to fatty liver disease and type 2 diabetes.

The format uses a typical clinical scenario as a tool for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case study will improve your knowledge and problem-solving skills in type 2 diabetes by encouraging you to make evidence-based decisions in the context of individual cases.

You are invited to respond to the questions by typing in your answers. In this way, you are actively involved in the learning process, which is hopefully a much more effective way to learn.

By actively engaging with these case histories, I hope you will feel more confident and empowered to manage such presentations effectively in the future.

Meet Cassie

Cassie is a 49-year-old with a 2-year history of type 2 diabetes. A non-smoker and moderate alcohol drinker, her HbA_1c is 55 mmol/mol and BMI is 32.1 kg/m².

When she attends the practice to be considered for statin therapy, she has high blood pressure and dyslipidaemia, and her liver function tests are elevated.

Cassie is currently taking metformin 1 g twice daily and lisinopril 10 mg daily.

By working through this interactive case study, you will consider the following issues and more:

• What is the most likely cause of Cassie’s raised liver function test results?
• Why is it important to establish if non-alcoholic fatty liver disease is present? 
• How does NAFLD impact on glycaemic control?
• What advice would you offer Cassie to manage her fatty liver disease?

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