{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T02:48:54Z","timestamp":1767926934933,"version":"3.49.0"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002954","name":"Universit\u00e0 degli Studi di Milano - Bicocca","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002954","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Diabetol"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Aims<\/jats:title>\n                <jats:p>Liver steatosis, a typical finding in patients with type 2 diabetes (T2D), can lead to cirrhosis and hepatocellular carcinoma. The aim of the present study is to estimate the awareness of liver disease among patients with T2D and whether it differs according to the degree of liver fibrosis estimated by transient elastography (TE).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This is a population-based cross-sectional study. We included all patients with T2D that participated in the 2017\u20132018 cycle of the National Health and Nutrition Examination Survey and underwent a TE examination. Presence of liver steatosis and fibrosis was assessed by the median values of controlled attenuation parameter and liver stiffness measurement, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among the 825 patients included in the analysis, 8.1% (95% CI 5.1%-12.7%) of patients with steatosis were aware of having a liver condition. Even if awareness increased proportionally with increasing severity of organ damage, it remained limited even among patients with advanced fibrosis (17.9%, 95% CI 8.8%-33.3%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Despite increasing evidence of a frequent hepatic involvement associated with poor prognosis, awareness of suffering of advanced liver disease in patients with T2D is remarkably low, likely reflecting little recognition also among the team of health care professionals.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00592-021-01677-y","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T10:03:33Z","timestamp":1611655413000},"page":"651-655","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Lack of awareness of liver organ damage in patients with type 2 diabetes"],"prefix":"10.1007","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2422-3041","authenticated-orcid":false,"given":"Stefano","family":"Ciardullo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommaso","family":"Monti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3024-0457","authenticated-orcid":false,"given":"Gianluca","family":"Perseghin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,1,26]]},"reference":[{"issue":"7","key":"1677_CR1","doi-asserted-by":"publisher","first-page":"1020","DOI":"10.1038\/ajg.2014.132","volume":"109","author":"G Zoppini","year":"2014","unstructured":"Zoppini G, Fedeli U, Gennaro N et al (2014) Mortality from chronic liver diseases in diabetes. Am J Gastroenterol 109(7):1020\u20131025. https:\/\/doi.org\/10.1038\/ajg.2014.132","journal-title":"Am J Gastroenterol"},{"key":"1677_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2019.04.038","author":"K Bjorkstrom","year":"2019","unstructured":"Bjorkstrom K, Franzen S, Eliasson B et al (2019) Risk factors for severe liver disease in patients with type 2 diabetes. Clin Gastroenterol Hepatol. https:\/\/doi.org\/10.1016\/j.cgh.2019.04.038","journal-title":"Clin Gastroenterol Hepatol"},{"issue":"1","key":"1677_CR3","doi-asserted-by":"publisher","first-page":"e000904","DOI":"10.1136\/bmjdrc-2019-000904","volume":"8","author":"S Ciardullo","year":"2020","unstructured":"Ciardullo S, Muraca E, Perra S et al (2020) Screening for non-alcoholic fatty liver disease in type 2 diabetes using non-invasive scores and association with diabetic complications. BMJ Open Diabetes Research & Care 8(1):e000904. https:\/\/doi.org\/10.1136\/bmjdrc-2019-000904","journal-title":"BMJ Open Diabetes Research & Care"},{"issue":"3","key":"1677_CR4","doi-asserted-by":"publisher","first-page":"419","DOI":"10.2337\/dc16-1787","volume":"40","author":"F Bril","year":"2017","unstructured":"Bril F, Cusi K (2017) Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: a call to action. Diabetes Care 40(3):419\u2013430. https:\/\/doi.org\/10.2337\/dc16-1787","journal-title":"Diabetes Care"},{"key":"1677_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2020.108358","author":"S Ciardullo","year":"2020","unstructured":"Ciardullo S, Sala I, Perseghin G (2020) Screening strategies for nonalcoholic fatty liver disease in type 2 diabetes: insights from NHANES 2005\u20132016. Diabetes Res Clin Pract. https:\/\/doi.org\/10.1016\/j.diabres.2020.108358","journal-title":"Diabetes Res Clin Pract"},{"issue":"6","key":"1677_CR6","doi-asserted-by":"publisher","first-page":"1717","DOI":"10.1053\/j.gastro.2019.01.042","volume":"156","author":"PJ Eddowes","year":"2019","unstructured":"Eddowes PJ, Sasso M, Allison M et al (2019) Accuracy of FibroScan controlled attenuation parameter and liver stiffness measurement in assessing steatosis and fibrosis in patients with nonalcoholic fatty liver disease. Gastroenterology 156(6):1717\u20131730","journal-title":"Gastroenterology"},{"key":"1677_CR7","unstructured":"Centers for disease control and prevention. 2017: National Health and Nutrition Examination Survey (NHANES). U.S. Department of health and human services. Available from https:\/\/wwwn.cdc.gov\/nchs\/data\/nhanes\/2017-2018\/manuals\/2017_MEC_Laboratory_Procedures_Manual.pdf accessed 31 March 2020."},{"issue":"4","key":"1677_CR8","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1007\/s10620-019-05700-9","volume":"65","author":"A Singh","year":"2020","unstructured":"Singh A, Dhaliwal AS, Singh S et al (2020) Awareness of nonalcoholic fatty liver disease is increasing but remains very low in a representative US Cohort. Dig Dis Sci 65(4):978\u2013986. https:\/\/doi.org\/10.1007\/s10620-019-05700-9","journal-title":"Dig Dis Sci"},{"issue":"1","key":"1677_CR9","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1097\/mcg.0000000000000075","volume":"49","author":"AC Wieland","year":"2015","unstructured":"Wieland AC, Mettler P, McDermott MT et al (2015) Low awareness of nonalcoholic fatty liver disease among patients at high metabolic risk. J Clin Gastroenterol 49(1):e6\u2013e10. https:\/\/doi.org\/10.1097\/mcg.0000000000000075","journal-title":"J Clin Gastroenterol"},{"issue":"2","key":"1677_CR10","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1111\/imj.13667","volume":"48","author":"PJ Patel","year":"2018","unstructured":"Patel PJ, Banh X, Horsfall LU et al (2018) Underappreciation of non-alcoholic fatty liver disease by primary care clinicians: limited awareness of surrogate markers of fibrosis. Intern Med J 48(2):144\u2013151. https:\/\/doi.org\/10.1111\/imj.13667","journal-title":"Intern Med J"},{"issue":"3","key":"1677_CR11","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1111\/j.1445-5994.2012.02848.x","volume":"43","author":"CJ Bergqvist","year":"2013","unstructured":"Bergqvist CJ, Skoien R, Horsfall L et al (2013) Awareness and opinions of non-alcoholic fatty liver disease by hospital specialists. Intern Med J 43(3):247\u2013253","journal-title":"Intern Med J"},{"issue":"30","key":"1677_CR12","doi-asserted-by":"publisher","first-page":"3361","DOI":"10.3748\/wjg.v24.i30.3361","volume":"24","author":"S Leoni","year":"2018","unstructured":"Leoni S, Tovoli F, Napoli L et al (2018) Current guidelines for the management of non-alcoholic fatty liver disease: a systematic review with comparative analysis. World J Gastroenterol 24(30):3361","journal-title":"World J Gastroenterol"}],"container-title":["Acta Diabetologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-021-01677-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00592-021-01677-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-021-01677-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T04:14:52Z","timestamp":1619496892000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00592-021-01677-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,26]]},"references-count":12,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2021,5]]}},"alternative-id":["1677"],"URL":"https:\/\/doi.org\/10.1007\/s00592-021-01677-y","relation":{},"ISSN":["0940-5429","1432-5233"],"issn-type":[{"value":"0940-5429","type":"print"},{"value":"1432-5233","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,26]]},"assertion":[{"value":"10 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No potential conflict of interest related to this article was reported.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Code is available from the corresponding author upon reasonable request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}},{"value":"Written informed consent was obtained from all adult participants.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The original survey was approved by the Centers for Disease Control and Prevention Research Ethics Review Board. The present analysis was deemed exempt by the Institutional Review Board at our institution, as the dataset used in the analysis was completely de-identified.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}