Brief report Should patients with type 2 diabetes and raised liver enzymes be referred for further evaluation of liver disease? Ingrid J. Hickman a, *, Anthony J. Russell a,b , Johannes B. Prins a,d , Graeme A. Macdonald a,c a Diamantina Institute for Cancer, Immunology and Metabolic Medicine, Ground Floor, Princess Alexandra Hospital, University of Queensland, Ipswich Road, Woolloongabba, QLD 4102, Australia b Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia c Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia d Centres for Health Research, Princess Alexandra Hospital, Brisbane, Australia 1. Introduction Raised liver enzymes are prevalent in diabetes clinics, but formal assessment for type and severity of underlying liver disease is not always a component of clinical care. Type 2 diabetes (T2DM) is a risk factor for a number of liver diseases including non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), chronic hepatitis C virus (HCV) infection and cirrhosis. T2DM is independently associated with accel- erated progression of fibrosis to cirrhosis. The presence of non-alcoholic steatohepatitis (NASH), the most severe form of NAFLD, co-morbidly increases the risk for cardiovascular events in this population [1,2]. Without appropriate follow up of raised liver enzymes, it is possible that significant liver injury may remain undiagnosed. We formally investigated raised liver enzymes in patients with T2DM attending a tertiary referral diabetes outpatient centre. The aim was to investigate the range of causes of diabetes research and clinical practice 80 (2008) e 10– e 12 article info Article history: Received 21 November 2007 Accepted 28 November 2007 Published on line 9 January 2008 Keywords: Type 2 diabetes NAFLD Cirrhosis Liver enzymes abstract Raised liver enzymes are common in type 2 diabetes (T2DM) but often considered benign. Non-alcoholic fatty liver was the cause in 65% of cases but other causes included alcoholic liver disease and viral hepatitis. Cirrhosis was identified in 11 patients. There is a significant burden of advanced liver diseases from a variety of aetiologies in patients with T2DM. # 2008 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +61 7 3240 2804; fax: +61 7 3240 2973. E-mail address: i.hickman@uq.edu.au (I.J. Hickman). Abbreviations: NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; ALD, alcoholic liver disease; T2DM, type 2 diabetes mellitus; HCV, hepatitis C virus; HBV, hepatitis B virus; GGT, gamma glutamyl transpeptidase; ALT, alanine transaminase; AST, aspartate transaminase; HCC, hepatocellular carcinoma. available at www.sciencedirect.com journal homepage: www.elsevier.com/locate/diabres 0168-8227/$ – see front matter # 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.diabres.2007.11.016