Why liver function tests are key for people with diabetes and obesity

Time of India

21-05-2025

Conceived as a princely minister of warmth and life, the liver is often overlooked in
diabetes
and
obesity
, whereas the organ is a prime regulator in metabolism. In recent times, a plethora of evidence has begun linking decreased liver performance with metabolic disorders. Thus stands the Liver Function Test (
LFT
) as an important investigative tool for all, ranging from diabetes to obesity or a combination of the two.
The Link Between Liver, Diabetes, and Obesity
The liver controls lipid metabolism and glucose metabolism. In type 2 diabetes patients, this equilibrium is lost because of insulin resistance, which generally leads to fat accumulation in the liver by a mechanism independent of alcohol, i.e., Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Likewise, obesity leads to excess fat deposition around organs, such as the liver, and sets them up for inflammation and fibrosis.
Without treatment, these disorders progress to cirrhosis and ultimately, even
liver cancer
in certain situations.
What
Liver Function Tests
Tell Us
Proceeding with LFTs, the following enzymes and proteins are measured:
ALT (SGPT)- a liver enzyme that helps detect
liver damage
or inflammation, especially in conditions like
fatty liver
, diabetes, and obesity.
ALP (Alkaline Phosphatase) - reports bile duct function
Bilirubin - the liver's power to clear waste
Albumin and Total Protein - the capacity of the liver to synthesise proteins
Elevated liver enzymes in patients with diabetes or obese individuals often indicate silent liver damage before the appearance of signs and symptoms.
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Why Routine Monitoring Is Important
Diabetes and obesity are
chronic conditions
. As a rule, and when patients with diabetes have a higher than normal BMI or altered lipid profile, LFTs must be checked, Black Book Reference American Diabetes Association. Similar recommendation in Indian guidelines. With obesity rates running at 12% in India and more than 100 million cases of diabetes recorded as per the ICMR-INDIAB study 2023, the burden of liver-related comorbidities is something one can only imagine.
Liver abnormalities alter drug metabolism, thereby possibly affecting diabetic treatment. In a diseased liver, drugs like metformin or statins undergo altered metabolism, which predisposes one to side effects.
Fibroscan
and Ultrasound Liver
Advanced liver fibrosis occurs more frequently in people with type 2 diabetes, often being caught late or never at all. FibroScan and ultrasound liver imaging are two such non-invasive methods for assessing liver stiffness with high accuracy, thus providing an early diagnosis.
On the Defensive
Good news is that the liver is mostly reversible in early stages. When combined with lifestyle changes (weight loss, low-carb diet, physical activity, and diabetes management), LFTs may be reversible in fatty liver conditions. Also, avoiding alcohol, good hydration, and paying attention to liver health every 6–12 months, provide good points of prevention against the long-term establishment of the disease.
Liver health is closely linked with diabetes and obesity, and often acts as a silent alarm system. Hence, regular liver function tests should be considered more of a preventive than just a diagnostic tool. For anyone struggling with blood sugar and weight issues, keeping an eye on their liver will be the key to keeping the metabolic system healthy throughout a long life.
Authored by: Dr. Sameer Bhati, Public health expert
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