Published on August 8, 2025
People with diabetes normally undergo regular testing for their kidney and eye function since diabetes could affect these organs. Recent evidence indicates that diabetes is also linked to a liver disease called Metabolic dysfunction-associated steatotic liver disease (MASLD), .
What is MASLD?
MASLD was formerly known as nonalcoholic fatty liver disease (NAFLD). In this condition, there is a buildup of fat in the liver along with at least one metabolic risk factor, such as overweight/obesity, hypertension, prediabetes, type 2 diabetes, high triglycerides, or low HDL cholesterol—without significant alcohol use. If uncontrolled, it can lead to advanced liver fibrosis (scarring of the liver), and even liver failure.
Why People with Diabetes Should Care for their Liver?
- MASLD is extremely common in people with type 2 diabetes—about two out of three are affected (nearly 70%).
- The relationship is bidirectional: MASLD increases the risk of developing type 2 diabetes, and type 2 diabetes raises the likelihood of MASLD becoming more severe.
- Most people with MASLD experience no symptoms until advanced disease develops, so screening and early diagnosis are crucial.
How to detect MASLD Early in Diabetes Patients?
Recent guidelines recommend screening for MASLD in diabetes patients using a simple blood test called the FIB-4 Index. This test calculates the risk of advanced liver fibrosis for based on age, liver enzyme levels, and platelet count. If the FIB-4 score is below 1.3, the risk of advanced liver fibrosis is considered low. In that case, the FIB-4 test can be repeated every 1–2 years.
If the FIB-4 score is 1.3 or higher, a second round of assessment becomes necessary. This typically involves a specialized imaging test called vibration-controlled transient elastography (VCTE). This test measures liver stiffness—a direct indicator of scarring. A liver stiffness measurement (LSM) of less than 8.0 kPa indicates a lower risk; continued monitoring with repeat imaging every 1–2 years is advised in such cases. Values of 8.0 kPa or above mean a high risk of advanced fibrosis, requiring referral to a liver specialist.
If VCTE isn’t available, a blood test called the Enhanced Liver Fibrosis (ELF) test may be used. An ELF score below 7.7 means the risk of fibrosis is very low, and the test should be repeated at least every two years. If the ELF score is 9.8 or above, advanced fibrosis is likely, and referral to a specialist is recommended.
Treatment options for MASLD are currently limited. If the patient is at a high risk for advanced liver disease, early detection could encourage the adoption of lifestyle modifications and therefore prevent progression of the condition.
Reference: Cusi Ket al. Metabolic Dysfunction–Associated Steatotic Liver isease (MASLD) in People With Diabetes: The Need for Screening and Early
Intervention. A Consensus Report of the American Diabetes Association
Diabetes Care 2025;48:1057–1082 | https://doi.org/10.2337/dci24-0094
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