Diabetes and Silent Liver Cirrhosis: The Hidden Crisis in India

On the eve of World Liver Day 2026, a new Lancet study has revealed that one in twenty adults in India has undiagnosed probable cirrhosis, positioning advanced liver disease as a major hidden complication of Type 2 Diabetes (T2D).

The DiaFib-Liver Study, conducted between January and July 2024, screened over 9,202 adults with T2D across diverse regions of India to establish a national benchmark for liver health. According to the findings published in Lancet Regional Health Southeast Asia, 26% of adults with T2D in India suffer from clinically significant liver fibrosis, meaning one in four have advanced scarring of the liver. 14% have developed advanced fibrosis, while 5% — equivalent to one in twenty — meet the criteria for probable cirrhosis, often without showing any symptoms.

These results have led researchers to identify liver disease as the “fourth major complication” of Type 2 Diabetes, joining the traditionally recognized complications of retinopathy (eye damage), nephropathy (kidney disease), and neuropathy (nerve damage). The study’s principal researchers, Dr Ashish Kumar of Sir Ganga Ram Hospital and Dr Anoop Misra of Fortis C-DOC, emphasized that the focus should shift from merely detecting fatty liver to assessing fibrosis, as fat accumulation and scarring do not always correlate.

The study highlights a dangerous dissociation between liver fat and actual fibrosis. For years, metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as fatty liver disease, was considered the primary liver concern in diabetic patients. However, the DiaFib-Liver Study shows that significant fibrosis and cirrhosis can occur even in the absence of severe steatosis, making reliance on fat-based screening insufficient and potentially misleading.

World Liver Day is observed annually on April 19 to raise awareness about liver health and the importance of early detection. In 2026, the theme underscores the growing burden of silent liver disease in populations with diabetes, particularly in low- and middle-income countries where access to routine screening remains limited. The researchers urge healthcare systems to integrate liver fibrosis assessment into standard diabetes care, using non-invasive tools like elastography to detect scarring before symptoms appear.