(Washington, D.C., April 13, 2021) – Global Liver Institute (GLI) and many of the leaders of the liver, diabetes and obesity advocacy community have submitted a formal letter and comments to the U.S. Preventive Services Task Force (USPSTF) urging the task force to mention the direct connection between diabetes and liver diseases, such as nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), in their recommendations for type 2 diabetes (T2D) and prediabetes screening. The current draft statement from USPSTF recommends screening adults ages 35 to 70 years who are overweight or obese for prediabetes and T2D but does not mention the strong link between T2D and chronic liver disease. See the letter and the Final Recommendation Statement.

“No current recommendations for patients with or at risk of type 2 diabetes can be considered accurate or evidence-based if they do not include reference to NAFLD and NASH. The omission of the clear interconnectedness of diabetes and fatty liver disease in determining and driving risk would be misleading and erroneous and would deprive people living with diabetes of the opportunity for appropriate interventions to reduce their risk for advanced liver disease, need for transplantation, cancer and death,” stated Donna R. Cryer, JD, president and CEO of  GLI. “While we appreciate that USPSTF has shared this draft statement and asked for comments, it doesn’t go far enough. We respectfully ask USPSTF to update the statement to acknowledge the direct connection between liver diseases such as NAFLD/NASH and diabetes. This additional language will help save lives and enable patients and providers to make more informed decisions.”

NASH is the most severe form of NAFLD, and it is common for patients to have both NASH and diabetes. For individuals with T2D, the prevalence of NAFLD affects 70% of adults in the U.S. with an estimated 30% having NASH and about 20% having liver fibrosis.1 2 3 4 Patients with T2D and NASH, moreover, have a higher risk of liver-related and non-liver related illness and premature death than those without liver disease.5

Signatories on the letter include: GLI, American Association for the Study of Liver Diseases, American Gastroenterological Association, Community Liver Alliance, Digestive Disease National Coalition, Endocrine Society, Fatty Liver Foundation, NASH kNOWledge, Liver Coalition of San Diego, Liver Wellness Foundation and Obesity Action Coalition.

About Global Liver Institute

Global Liver Institute (GLI) is a 501(c)(3) tax-exempt not-for-profit organization, headquartered in Washington, D.C., United States, with offices in the U.S. and Europe. GLI’s vision is for liver health to take its place on the global public health agenda commensurate with the prevalence and impact of liver disease. GLI’s mission is to improve the lives of individuals and families impacted by liver disease through promoting innovation, encouraging collaboration, and supporting the scaling of optimal approaches to help eradicate liver diseases. Follow us on TwitterFacebookInstagram, and LinkedIn.


(1) Portillo-Sanchez, P., Bril, F., Maximos, M., Lomonaco, R., Biernacki, D., Orsak, B., Subbarayan, S., Webb, A., Hecht, J., & Cusi, K. (2015). High Prevalence of Nonalcoholic Fatty Liver Disease in Patients With Type 2 Diabetes Mellitus and Normal Plasma Aminotransferase Levels. The Journal of clinical endocrinology and metabolism100(6), 2231–2238. https://doi.org/10.1210/jc.2015-1966

(2) Lomonaco, R., Godinez Leiva, E., Bril, F., Shrestha, S., Mansour, L., Budd, J., Portillo Romero, J., Schmidt, S., Chang, K. L., Samraj, G., Malaty, J., Huber, K., Bedossa, P., Kalavalapalli, S., Marte, J., Barb, D., Poulton, D., Fanous, N., & Cusi, K. (2021). Advanced Liver Fibrosis Is Common in Patients With Type 2 Diabetes Followed in the Outpatient Setting: The Need for Systematic Screening. Diabetes care44(2), 399–406. https://doi.org/10.2337/dc20-1997

(3) Ciardullo, S., Monti, T., & Perseghin, G. (2021). High Prevalence of Advanced Liver Fibrosis Assessed by Transient Elastography Among U.S. Adults With Type 2 Diabetes. Diabetes care44(2), 519–525. https://doi.org/10.2337/dc20-1778

(4) Younossi, Z. M., Golabi, P., de Avila, L., Paik, J. M., Srishord, M., Fukui, N., Qiu, Y., Burns, L., Afendy, A., & Nader, F. (2019). The global epidemiology of NAFLD and NASH in patients with type 2 diabetes: A systematic review and meta-analysis. Journal of hepatology71(4), 793–801. https://doi.org/10.1016/j.jhep.2019.06.021

(5) Cusi, K. (2020, February). Time to Include Nonalcoholic Steatohepatitis in the Management of Patients With Type 2 Diabetes. Diabetes Care, 43(2): 275-279. https://doi.o rg/10.2337/dci19-0064