Experts call for regular screening of metabolic dysfunction-associated steatotic liver disease in adults with type 2 diabetes and prediabetes, emphasising the importance of integrated liver health in routine diabetes management and early intervention strategies.
Adults with type 2 diabetes, and some people with prediabetes, should be screened for metabolic dysfunction-associated steatotic liver disease, according to speakers at the Association of Diabetes Care & Education Specialists annual meeting. Susan Cornell, a professor emeritus at Midwestern University College of Pharmacy, said the condition is common in diabetes and often missed because it can progress quietly. She argued that liver health now belongs in routine diabetes care, alongside blood glucose, heart and kidney risk.
Cornell said about 70% of people with type 2 diabetes and 20% of those with type 1 diabetes may have MASLD, and roughly half of those with diabetes and MASLD will go on to develop metabolic dysfunction-associated steatohepatitis, the more inflammatory form of the disease. Kathy Warwick, a diabetes care and education specialist and registered dietitian, said diagnosis is complicated by the lack of symptoms, confusion over terminology and a tendency for both patients and clinicians to underplay the liver findings. She also pointed to a shortage of clear treatment pathways, with resmetirom and semaglutide the only FDA-approved medicines specifically cited for the condition.
Warwick said the American Diabetes Association’s 2026 Standards of Care recommend screening people with prediabetes or type 2 diabetes who have obesity, cardiometabolic risk factors or established cardiovascular disease using the Fibrosis-4 index, a simple blood-based fibrosis risk tool. Screening is also advised for adults with type 2 diabetes and alanine aminotransferase levels above 30 U/L. If the Fibrosis-4 score is 1.3 or higher, further assessment is advised, with referral to a gastroenterologist or hepatologist for higher-risk patients. The CDC and Mayo Clinic both stress that lifestyle change remains central, especially healthier eating, more physical activity and weight control, while Harvard Health notes that MASLD is often symptom-free.
On treatment, Cornell said the aim is not just liver protection but also better cardiorenal risk reduction, glucose control and weight management. She highlighted incretin-based therapies, including GLP-1 receptor agonists and GLP-1/GIP dual agonists, as options that may address several problems at once, while also noting the potential role of pioglitazone, SGLT2 inhibitors and resmetirom. But both speakers stressed that medication should support, not replace, lifestyle measures. Warwick said small changes in calorie intake and activity can improve liver fat, while Cornell told the audience that “medicine is always added to lifestyle”.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
