A landmark study has identified diabetes as a major driver of advanced liver disease in India, warning that lakhs of patients are moving toward liver failure without any obvious symptoms.
Published in The Lancet, the DiaFib-Liver Study is being described as the largest real-world survey of its kind conducted in a developing nation. The study screened 9,202 adults across 27 hospitals and clinics in India and found that one in four patients had clinically significant liver scarring, one in seven had advanced disease, and one in 20 had already reached the threshold of probable cirrhosis.
Dr Ashu Rastogi, principal investigator at the Post Graduate Institute of Medical Education and Research (PGIMER), said diabetes is now the “mother of modern liver disease”. He noted that diabetes and obesity have overtaken Hepatitis B and C as the main causes of liver transplants in clinical wards.
The study pointed to hepatic insulin resistance as a key mechanism behind the damage, in which fat buildup causes the liver to stop responding properly to insulin, leading to chronic inflammation and scarring. It also challenged the assumption that only overweight people are at risk, finding significant scarring in lean individuals and in patients without visible liver fat.
Researchers identified a phenomenon known as “burnt-out” liver disease, in which fat disappears as scarring worsens, leaving the liver shrunken and non-functional. In such cases, age and the long-term impact of high blood sugar were found to be the strongest predictors of damage.
Because liver disease often remains silent until it is advanced, the study called for stronger screening efforts. It said standard ultrasounds are not enough for early detection and recommended the FIB-4 score, which uses routine blood tests, along with FibroScans, to identify at-risk patients before irreversible damage develops.
The findings also underscored the potential for reversal through lifestyle changes. Experts said 5% weight loss can reverse scarring in up to 60% of patients, while 10% weight loss can stop advanced fibrosis in nearly half of cases.
The study comes as the global diabetic population exceeds 50 crore, with cases projected to reach 78 crore by 2045. India currently has 10.1 crore people with diabetes and another 13.6 crore classified as pre-diabetic, placing the country at the centre of the growing crisis.
