Bill is a 50 year old male whom has NASH who comes in for his diabetic check up with you. He saw the hepatologist last month and had a repeat liver biopsy. His fibrosis score on biopsy showed a stage 3 fibrosis. 4 years ago it was stage 2. Bill has T2DM and is on metformin and Lantus. His HgB A1C is 7.1. His BMI is 39 kg/m2. He is also on lisinopril and atorvastatin. Currently, all labs including glomerular filtration rate and liver transamines are all within normal limits . Bill is concerned about the progression of his NASH and wants to lose weight. He does not drink alcohol. He admits to you that he needs to eat less carbs but he can’t find the motivation to do it. He knows the hepatologist told him he needs to lose weight, but he is having trouble deciding how he can do this. The hepatologist also gave him a prescription for Victoza but Bill is not sure why.
Like Bill, patients with NAFLD often have co-occuring hypertension, dyslipidemia, and diabetes mellitus that all need to be treated. You educate Bill that the hepatologist gave him Victoza due to his HgB A1C showing need for better control and a small study showing a beneficial effect of GLP-1 on slowing fibrosis progression in NASH. GLP-1s can also induce weight loss. (GLP-1s are not recommended by current guidelines for NASH but are being used in clinical practice by specialists when more diabetic control is needed). During a motivational interviewing session with you, Bill develops a plan to make lifestyle changes. He also agrees to see the dietician for a refresher on dietary changes. He joins Fitness Fun (a local gym) and hires a personal trainer. Over the next 6 months, he loses 10% of his body weight. Bill can remain on atorvastatin and would only need to be taken off of it if he develops decompensated cirrhosis.
Review a transcript of part of the conversation that took place between you and Bill using motivational interviewing.