Non-alcoholic fatty liver disease and type 2 diabetes mellitus: general approaches to the choice of therapy

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Abstract

Currently, there is a growing interest in one of the most common diseases in hepatology – non-alcoholic fatty liver disease (NAFLD). There is evidence that approximately 75% of cases of NAFLD occur against the background of obesity, dyslipidemia or type 2 diabetes mellitus (T2DM). At the present stage, a persistent pathophysiological interaction between NAFLD and T2DM has been demonstrated. Insulin resistance is one of the main pathogenetic causes of the development of T2DM and NAFLD. At the same time, it is necessary to highlight the role of the intestinal microbiota and epigenome in the manifestation and progression of NAFLD. Therefore, treatment approaches should be comprehensive. Diet therapy should be aimed at calorie restriction. However, in real clinical practice, phisicians face a low commitment to appropriate and long-term dietary recommendations necessary for weight loss. At the same time, use of dietary fibers, which are part of the preparation Mucofalk, helps to slow down the passage of food through the digestive tract, increase the saturation period. Use of a low-calorie diet with a significant fat restriction may increase the risk of gallstones. Ursodeoxycholic acid preparations (Ursofalk) can be recommended for the prevention of cholelithiasis. Considering the role of intestinal microflora in the pathogenesis of NAFLD, it is necessary to correct dysbiotic changes as well as basic pharmacotherapy. Thus, a comprehensive approach to the management of patients with NAFLD and T2DM should be aimed not only at therapy, but also at the prevention of associated metabolic disorders.

About the authors

Nina A. Petunina

Sechenov First Moscow State Medical University (Sechenov University)

Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-9390-1200

чл.-кор. РАН, д-р мед. наук, проф., зав. каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Milena E. Telnova

Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-8007-9721

кандидат медицинских наук, доцент кафедры эндокринологии им. Н.В. Склифосовского

Russian Federation, Moscow

Ekaterina V. Goncharova

Sechenov First Moscow State Medical University (Sechenov University)

Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-7025-8427

канд. мед. наук, доц. каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Narine S. Martirosian

Sechenov First Moscow State Medical University (Sechenov University)

Email: milena.telnova@mail.ru
ORCID iD: 0000-0002-0202-1257

канд. мед. наук, доц. каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

Irina A. Kuzina

Sechenov First Moscow State Medical University (Sechenov University)

Email: milena.telnova@mail.ru
ORCID iD: 0000-0001-7923-4894

ассистент каф. эндокринологии Института клинической медицины им. Н.В. Склифосовского

Russian Federation, Moscow

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Supplementary files

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2. Fig. 1. Major pathogenetic links in non-alcoholic fatty liver disease.

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3. Fig. 2. Methods of Using Mukofalk Drug.

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4. Fig. 3. Carbon dioxide exchange effects of ursodoxycholic acid.

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5. Fig. 4. Action of high doses of ursodoxycholic acid (25–30 mg/kg) on carbohydrate metabolism in patients with non-alcoholic steatohepatitis.

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