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The Link Between Diabetes and Liver Fibrosis

Over eleven million Canadians are living with diabetes or prediabetes. Diabetes disrupts the body's ability to produce or effectively use insulin, leading to high blood sugar levels which, over time, can cause serious health issues. In this article, we will delve deeper into the connection between diabetes and liver fibrosis, and how you can take proactive steps to protect your health.

Understanding diabetes types

There are two main types of diabetes:

  1. Type 1 Diabetes is often called juvenile onset diabetes because it is typically diagnosed in children, requiring lifelong insulin injections as the body does not produce enough insulin.
  2. Type 2 Diabetes, also known as adult-onset diabetes, results from the body’s improper use of insulin and can often be managed through diet and/or medication.

Diabetes and liver fibrosis – how are they connected?

Diabetes raises the risk of developing non-alcoholic fatty liver disease (NAFLD) and the progression of the disease. There’s also evidence that having a liver disease can contribute to the onset of Type 2 diabetes. NAFLD is a major cause of liver fibrosis worldwide so if you have diabetes, or prediabetes, screening is important. If left untreated, it raises your risk of developing advanced liver fibrosis as well as liver cancer, heart disease, and kidney disease.

Screening for liver fibrosis

LifeLabs offers two new testing options that both use simple blood tests to accurately measure the risk of developing advanced liver fibrosis and other liver-related issues in NAFLD patients.

  1. Fibrosis-4 (FIB-4) Index uses the results of three liver function tests to calculate a score that can act as a ‘red flag’ for early identification of patients at elevated risk of developing advanced liver fibrosis. FIB-4 is recommended as the initial test to assess liver fibrosis progression in NAFLD patients. Please note that currently the FIB-4 Index is only available in Ontario.
  2. Enhanced Liver Fibrosis (ELFTM) Score calculates a simple score to measure advanced fibrosis and the likelihood of disease progression to cirrhosis. ELF (Enhanced Liver Fibrosis) is recommended as a follow up test in high-risk patients based on FIB-4 results. Please note that currently the ELFTM Score is only available in Ontario.

    To learn more about ELFTM, please visit here.

You can also download this helpful guide and bring it to your next medical appointment to discuss liver fibrosis testing with your health care provider (HCP).

Download Guide

Being proactive can protect your health

Below are some proactive steps you can take if you have diabetes or are concerned that you may be at risk:

  1. Talk to your HCP to find out if liver fibrosis testing is right for you
    Understanding the connections between diabetes and liver fibrosis is essential for managing your health. Regular screenings and consultations with your HCP can lead to a healthier future. Based on your risk level they may recommend FIB-4 and/or ELFTM Score for early identification of NAFLD and other liver-related events.

    To learn more about liver fibrosis testing, please click here

  2. Consider enrolling in LifestyleRx to make lifestyle changes to benefit your health
    LifestyleRx is a virtual physician-led program that helps patients adopt lifestyle changes to achieve sustainable remission of Type 2 diabetes. The program is available at no cost to patients with OHIP (Ontario Health Insurance Plan) and MSP (Medical Services Plan) coverage.

    Through a 12-week diabetes program, patients receive personalized education and virtual care support that focuses on areas like diet, sleep, light exercise, stress reduction, and more to achieve key lifestyle changes to manage their condition.

    The LifestyleRx physicians work in collaboration with patients’ primary care providers and specialists to help patients achieve their best outcome.

    To learn more about this innovative program, please click here


    1. Diabetes and Liver Disease: Connection and Risks (
    2. Diabetes: How do I help protect my liver? – Mayo Clinic
    3. Fatty Liver and Type 2 Diabetes » Diabetes Institute » College of Medicine » University of Florida (
    4. 2022 Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings | American Association of Clinical Endocrinology (

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