In this episode of Diabetes Dialogue, cohostsDiana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and co-director of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, examine a newly released American Diabetes Association (ADA) consensus report titled Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in People with Diabetes: The Need for Screening and Early Intervention. The publication emphasizes the importance of recognizing MASLD as a critical comorbidity in individuals with type 2 diabetes and prediabetes and outlines guidance for clinicians to improve early detection, risk stratification, and treatment strategies.

The episode begins by placing MASLD in historical context alongside other comorbidities such as cardiovascular disease, chronic kidney disease, and hypertension. The hosts explain that MASLD, previously referred to as nonalcoholic fatty liver disease or NAFLD, reflects a metabolic-driven pathology and is now better understood as a progressive condition that increases the risk of cirrhosis, liver transplantation, cardiovascular disease, and impaired quality of life. The more advanced form, MASH (Metabolic dysfunction-associated steatohepatitis), represents progression toward hepatic fibrosis and cirrhosis.

A major focus is the Fibrosis-4 (FIB-4) score, a noninvasive, cost-effective screening tool calculated from common laboratory tests (platelets and liver function markers) to assess fibrosis risk. The consensus report advises routine FIB-4 scoring in adults with type 2 diabetes, particularly those with central obesity. Based on risk thresholds, further evaluation may involve transient elastography (FibroScan), advanced imaging, or hepatology referral.

The hosts commend the ADA for offering a clear clinical algorithm for evaluation and referral, as well as pharmacotherapy recommendations tailored to disease severity. For individuals with early-stage fibrosis, lifestyle modification and diabetes therapies such as GLP-1 receptor agonists (eg, semaglutide) are first-line approaches. For advanced fibrosis (F2–F3), resmetirom is the only currently approved treatment for MASH. The report also highlights complications from hepatic dysfunction—including impaired hypoglycemia awareness and sarcopenia—underscoring the broader metabolic impact of MASLD.

Isaacs and Bellini stress that MASLD should be approached with the same clinical rigor as other diabetes-related complications. They recommend integrating automated FIB-4 scoring in EHRs, interdisciplinary collaboration with hepatology, and clinician education using decision tools from the consensus report.

Reference:

Cusi K, Abdelmalek MF, Apovian CM, et al. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in People With Diabetes: The Need for Screening and Early Intervention. A Consensus Report of the American Diabetes Association. Diabetes Care. Published online May 28, 2025. doi:10.2337/dci24-0094