Data Show Those With Diabetes, NAFLD/NASH Have Twice Mortality Rate of Others in Medicare

Results were presented recently at the 79th Scientific Sessions of the American Diabetes Association.

Medicare beneficiaries who had both diabetes and nonalcoholic fatty liver disease (NAFLD) or a more advanced version of inflammation and fat buildup, known as nonalcoholic steatohepatitis (NASH), had 2 times the mortality rate of the general population, according to data presented last week at the 79th Scientific Sessions of the American Diabetes Association (ADA).

The Global Liver Institute is raising awareness about NAFLD and NASH, and Wednesday marked the second International NASH Day. Both NAFLD and NASH are increasing worldwide with the increased prevalence of obesity, which now affects more than 650 billion people.

The economic costs of NAFLD and NASH are high—slightly more than $1 trillion per year in the United States alone. The implications are important for Medicare, since the diseases are becoming the leading cause of liver transplant in the United States.

Diagnosis of NASH is difficult, as a definitive diagnosis requires a liver biopsy. However, Quest Diagnostics has developed the NAFLD Fibrosis Score Panel, a noninvasive tool to identify patients whose disease has progressed to liver fibrosis.

In the study presented at ADA, those with both diabetes and NAFLD/NASH had an overall mortality rate of 25.1%, compared with the expected rate of 12.7% over the 8-year study period. Researchers used a 20% sample of Medicare beneficiaries from 2007 to 2015, identifying patients with International Statistical Classification of Diseases and Related Health Problems (ICD) and medication codes.

The study identified 100,098 patients with NALFD/NASH, 2520 with compensated cirrhosis, 45,881 with decompensated cirrhosis, 408 with a liver transplant and 284 with hepatocellular carcinoma. Comorbidities were common—at least 71% had cardiovascular disease.

The relationship among diabetes and cardiovascular disease is seen among many patients who develop NAFLD. Preventing progression through weight loss and other steps represents the best approach so far, since efforts to find a treatment have not succeeded.

Mortality rates in 1 year were:

  • 18.1% for decompensated cirrhosis patients
  • 4.3% for the compensated cirrhosis patients
  • 2.1% for those with NAFLD/NASH only

Liver disease progression was higher in those with compensated cirrhosis with diabetes compared to those without diabetes (20% vs 17%).


Loomba R, Fraysse J, Li S, Ozbay AB, Harrison SA. High risk of mortality and disease progression associated with diabetes mellitus (DM) and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (NAFLD/NASH) in Medicare patients. Presented at: 79th Scientific Sessions of the American Diabetes Association; San Francisco, California; June 7-12, 2019. Abstract number 1450-P.