The Nexus of NASH and T2DM The Emerging Role of the Diabetologist

Kenneth Cusi, MD, FACP, FACE (Chair); Stephen A. Harrison, MD (Virtual Professor); Arun J. Sanyal, MBBS, MD, FAASLD; Zobair M. Younossi, MD, MPH, FACP, FACG, AGAF, FAASLD

Jointly provided by Postgraduate Institute for Medicine and Integritas Communications


This activity is supported by independent educational grants from Gilead Sciences, Inc.

Target Audience

This activity is intended for endocrinologists, diabetologists, diabetes nurse specialists, and diabetes educators engaged in the care of patients with type 2 diabetes mellitus (T2DM) and attendant increased risks of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH).

Statement of Need/Program Overview

NAFLD is a spectrum of potentially progressive liver disorders, ranging from simple hepatic steatosis to such severe forms as NASH, fibrosis, and cirrhosis.1 The prevalence rates of both NAFLD and NASH have been steadily trending upwards for years, mirroring the rapid and well-documented expansions of patient populations with obesity and/or T2DM.2-4 Thus, in the coming decade, burdens associated with this under-recognized epidemic are likely to increase exponentially for patients, clinicians, and health care systems.2-4 Of note, NAFLD is extremely common in individuals with T2DM, and the presence of both disorders significantly increases the likelihood that steatohepatitis and cirrhosis will develop compared with NAFLD cohorts without persistent hyperglycemia.4,5 Thus, endocrinologists and other clinicians with a focus on diabetes management are essential to accelerating the identification of patients with NAFLD. Importantly, however, appropriate diagnostic and management approaches for patients with T2DM who have advanced fibrosis markedly differ from those for patients who have received an NAFLD diagnosis, and best-practice strategies are quickly evolving.5 During this Interactive Exchange™ program, expert faculty will highlight epidemiologic and pathophysiologic relationships between NASH and T2DM, review recommendations for disease diagnosis and patient referral, and discuss current management options and the latest evidence for emerging NASH therapies.


  1. Haas JT, et al. Pathophysiology and mechanisms of nonalcoholic fatty liver disease. Annu Rev Physiol. 2016;78:181-205.
  2. Hassan K, et al. Nonalcoholic fatty liver disease: a comprehensive review of a growing epidemic. World J Gastroenterol. 2014;20(34):12082-12101.
  3. Estes C, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.
  4. Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci. 2016;17(5):774.
  5. Singh A, et al. Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in type-2 diabetic patients via non-invasive methods. J Hepatol. 2017;66(suppl 1):S150.

Educational Objectives

Upon completion of this activity, participants will be able to:

  • Describe pathophysiologic mechanisms linking obesity, T2DM, and NASH
  • Evaluate patients with prediabetes or T2DM to appropriately screen for NAFLD/NASH and monitor disease progression
  • Discuss the mechanisms of action and clinical trial data for current and emerging NASH therapies
  • Implement best practices for multidisciplinary management of NASH in the endocrinology/diabetes setting


Kenneth Cusi, MD, FACP, FACE (Chair)
Professor of Medicine
Chief, Division of Endocrinology, Diabetes and Metabolism
The University of Florida
Gainesville, Florida

Stephen A. Harrison, MD (Virtual Professor)
Medical Director
Pinnacle Clinical Research
San Antonio, Texas

Arun J. Sanyal, MBBS, MD, FAASLD
Professor of Medicine, Physiology and Molecular Pathology
Virginia Commonwealth University (VCU)
Richmond, Virginia

Zobair M. Younossi, MD, MPH, FACP, FACG, AGAF, FAASLD 
Chairman, Department of Medicine
Professor of Medicine
Inova Fairfax Medical Campus
Falls Church, Virginia

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine (PIM) and Integritas Communications. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Physician Credit Designation

The Postgraduate Institute for Medicine designates this live activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nursing Credit Designation

The maximum number of hours awarded for this Continuing Nursing Education activity is 1.2 contact hours, and 0.2 Pharmacotherapy contact hours for Advance Practice Registered Nurses.

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in health care and not a specific proprietary business interest of a commercial interest.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

Kenneth Cusi, MD, FACP, FACE: no relevant financial relationships.

Stephen A. Harrison, MD: Consulting Fees: AbbVie Inc., Alexion Pharmaceuticals, Inc., Bristol-Myers Squibb, Cirius Therapeutics, Civ., Corcept Therapeutics Incorporated, CymaBay Therapeutics, Echosens, Gilead Sciences, Inc., Histoindex Pte. Ltd., Innovate Biopharmaceuticals Inc., IQVIA, Madrigal Pharmaceuticals, Inc., Medpace, Inc., Metacrine, Inc., NGM Biopharmaceuticals, Inc., Novartis International AG, Novo Nordisk Inc., Perspectum Diagnostics Ltd., Pfizer Inc., The Pharmaceutical Product Development, LLC, Prometheus Laboratories Inc., Shenzhen Hightide Biopharmaceutical Ltd; Contracted Research: Bristol-Myers Squibb, Cirius Therapeutics, Inc., Conatus Pharmaceuticals Inc., CymaBay Therapeutics, GENFIT, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Madrigal Pharmaceuticals, Inc., NGM Biopharmaceuticals, Inc., Pfizer Inc; Ownership Interest: Cirius Therapeutics, GENFIT, Madrigal Pharmaceuticals, Metacrine, Inc.

Arun J. Sanyal, MBBS, MD, FAASLD: Consulting Fees: Ardelyx, Inc., Eli Lilly and Company, Gilead Sciences, Inc., HemoShear Therapeutics, LLC, Mallinckrodt Pharmaceuticals, Nimbus Therapeutics, LLC, Nitto Denko Technical Corporation, Pfizer Inc., Salix Pharmaceuticals, Sanyal Biotechnology; Contracted Research: Bristol-Myers Squibb, Conatus Pharmaceuticals Inc., Galectin Therapeutics, Inc., Gilead Sciences, Inc., Mallinckrodt Pharmaceuticals, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Salix Pharmaceuticals, Sequana Medical AG; Salary: Sanyal Biotechnology; Ownership Interest: Akarna Therapeutics Ltd., GENFIT SA, Natural Shield, NewCo LLC, Tiziana Life Sciences plc

Zobair M. Younossi, MD, MPH, FACP, FACG, AGAF, FAASLD: Consulting Fees: Bristol-Myers Squibb, Conatus Pharmaceuticals Inc., Enterome Bioscience, Gilead Sciences, Inc., Intercept Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Salix Pharmaceuticals, Vertex Pharmaceuticals Incorporated

The PIM planners and managers have nothing to disclose. The Integritas Communications planner and manager, Jim Kappler, PhD, has nothing to disclose.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. PIM and Integritas Communications do not recommend the use of any agent outside of the labeled indications. 

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Fee Information & Refund/Cancellation Policy

There is no fee for this educational activity.

Instructions to Receive Credit

In order to receive credit for this activity, the participant must score at least 70% on the posttest and complete the program evaluation.

PIM Contact Information

For information about the accreditation of this program, please contact PIM via email at

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expiration 09/16/2019

type Webcast