Experts speaking at the SID congress estimate that metabolic dysfunction-associated steatotic liver disease (MASLD), together with its inflammatory form MASH, affects as many as 70 percent of people with type 2 diabetes, ad-hoc-news.de reports. The figure, presented at the diabetes conference, places liver disease among the most common complications of the condition. It arrives alongside a wave of diagnostic research aimed at catching liver damage earlier and sparing patients invasive biopsies.
Why it matters
Fatty liver disease often develops without obvious symptoms, which means many people with diabetes may carry it without knowing. The numbers reported at the congress suggest the scale is far larger than routine care might imply.
Data from the University of Florida hospitals, described by ad-hoc-news.de, point in the same direction. A cross-sectional study of 1,446 adults there found MASLD in 68 percent of participants with type 2 diabetes and in 55 percent of those with prediabetes. Among patients who had both obesity and type 2 diabetes, 16 percent showed significant liver fibrosis.
A separate study published in Diabetology & Metabolic Syndrome, covering 759 hospitalized patients with type 2 diabetes, linked liver fat directly to blood sugar control. According to that analysis, each five-percentage-point rise in the ultrasound-derived liver fat fraction (UDFF) was associated with a 1.253-fold increase in the likelihood of an HbA1c of at least 7.0 percent.
Blood tests fall short in early stages
With case numbers this high, researchers have been testing whether lab-based markers can replace or reduce the need for biopsies. Results from the European LITMUS project, which analyzed data from 1,590 patients across 13 countries, suggest the answer is not yet.
No blood test examined in the project met the required threshold for detecting early disease in patients without fibrosis, according to the reporting. Several assays did perform reliably once fibrosis or cirrhosis was already advanced.
One test stood out. The SOMAScan proteomics panel was the only method in LITMUS that met the thresholds for identifying the risk of steatohepatitis (MASH). The analysis also found that a simple gamma-GT blood test outperformed FIB-4, the current clinical standard score, as a first-line diagnostic step.
Other work points toward protein-based approaches. A validated study published in Cell & Bioscience examined a signature of eleven proteins isolated from extracellular vesicles in blood plasma. That signature detected advanced fibrosis stages with an accuracy corresponding to an AUROC of 0.807.
A stepwise path to diagnosis
Rather than relying on a single test, specialists are increasingly recommending sequential pathways. A published scoping review cited in the reporting describes a route that begins with initial triage using the FIB-4 index, followed by transient elastography. That sequence, the review found, improves the identification of advanced fibrosis while cutting down on unnecessary referrals to specialists.
Imaging now has a formal place in treatment guidance as well. The joint guideline from EASL, EASD and EASO ties liver stiffness measurement (LSM) by VCTE, commonly known as FibroScan, into the care pathways for modern MASH therapies such as resmetirom and semaglutide.
For access to drug treatment in patients without cirrhosis, the guideline sets a specific bar: either a biopsy-confirmed fibrosis stage of F2 to F3, or a liver stiffness value between 10 and 20 kilopascals.
The reporting also notes that exercise can meaningfully reduce liver fat, a reminder that lifestyle measures remain part of the picture alongside diagnostic advances.
What to watch: whether the stepwise FIB-4 and elastography pathway, and newer protein signatures, move from research settings into routine diabetes care, and how quickly the joint EASL, EASD and EASO guidance reshapes screening for the roughly two-thirds of type 2 diabetes patients who may be living with fatty liver disease.
