CHENNAI: A silent but significant liver disease burden is emerging among people with type 2 diabetes, with a large India-wide study, featuring key inputs from a leading Chennai-based diabetes centre, finding that one in four patients already has serious liver damage without showing symptoms.
The DiaFib-Liver Study, which analysed data from over 9,200 adults across the country, has revealed that 26% of diabetics have clinically significant liver fibrosis, while 5% meet thresholds suggestive of cirrhosis, a late and potentially life-threatening stage of liver disease.
Researchers from the Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre in Chennai were among the contributors to the multi-centre study. The study was published in The Lancet Regional Health – Southeast Asia, an Elsevier journal, by a multi-institutional team of Indian researchers led by Dr Ashish Kumar.
Describing the findings as a critical shift in understanding diabetes-related complications, the authors said, “Advanced liver disease should be regarded as a ‘fourth major complication’ of diabetes, alongside eye, kidney and nerve damage.”
The findings carry particular relevance for Tamil Nadu, where urban centres such as Chennai have a high prevalence of diabetes driven by sedentary lifestyles and dietary patterns. The study found that 14% of patients had advanced fibrosis, indicating progressive liver damage, even though all participants were asymptomatic and were not being treated for liver disease.
Importantly, the research challenges conventional clinical markers. A notable proportion of patients with significant liver damage were non-obese, and some had no detectable fatty liver, suggesting that fibrosis can develop independently and remain clinically silent. “Fibrosis, not steatosis, should be the focus of systematic assessment in diabetes care,” the researchers noted, calling for a shift away from relying solely on fatty liver detection.
The analysis identified obesity, longer duration of diabetes, dyslipidaemia and reduced kidney function as key risk factors associated with liver fibrosis. Regional trends showed higher prevalence in parts of southern India, pointing to the need for region-specific screening strategies.
Doctors say the lack of symptoms is a major concern. Many patients are diagnosed only at advanced stages, when complications such as cirrhosis have already set in, limiting treatment options.
The study has called for routine liver fibrosis screening to be integrated into diabetes care, similar to annual eye and kidney evaluations. Non-invasive tools such as transient elastography can help identify high-risk patients early, the authors said.
Given TN’s growing diabetes burden, experts say incorporating liver assessment into standard care protocols could significantly reduce long-term complications and healthcare costs.
1 in 4 diabetics has serious liver damage; 1 in 20 may already have cirrhosis despite no symptoms
Landmark India-wide study (9,200+ patients) with key input from Chennai’s Dr Mohan’s Diabetes Specialities Centre
Establishes liver disease as the ‘fourth major complication’ of diabetes
14% show advanced fibrosis, signalling progressive and often irreversible damage
Not just obese patients: significant cases seen in non-obese and those without fatty liver
Major risk factors: long diabetes duration, obesity, high cholesterol, kidney issues
South India shows higher burden, making findings crucial for TN
Disease largely silent; many cases detected only at advanced stages
Study urges shift from fatty liver focus to fibrosis-based screening
Calls for routine liver testing in all diabetics, on par with eye and kidney checks