Real-world screening for metabolic dysfunction-associated steatotic liver disease among adults with type 2 diabetes.
TL;DR
The impact of population-level MASLD screening is limited by implementation barriers and future efforts should focus on direct-to-patient outreach and methods to identify patients without competing risks who are most likely to benefit from MASLD diagnosis and specific treatment.
Abstract
Background
New treatments for metabolic dysfunction-associated steatotic liver disease (MASLD) require identification of patients at risk of progressing to cirrhosis, yet population-based screening methods are not well established.
Methods
We conducted a pilot screening study at a large academic primary care practice among patients with type 2 diabetes mellitus (T2DM). We calculated FIB-4 scores on existing labs and contacted providers with recommendations for additional testing with vibration-controlled transient elastography (VCTE) and/or specialty referral.
Results
Among 2773 patients with T2DM seen at our clinic during the study period meeting inclusion criteria, 2396 had sufficient data to calculate FIB-4. After excluding lab results from the emergency department or inpatient setting, this left a final sample of 1315 patients. Among the 1315 patients included in the study, 78 (5.9%) had FIB-4 scores >2.66, while 732 (55.7%) had FIB-4 scores between 1.3 and 2.66. The diagnostic yield (proportion of patients receiving definitive diagnosis of MASLD with F2 or higher fibrosis as a result of the intervention) among the cohort with FIB-4 > 2.66 was 12/78 (15.4%). The most common reason for fall-out was the patient not wishing to receive further evaluation, with the second being provider concerns about competing risks.
Discussion
The impact of population-level MASLD screening is limited by implementation barriers. Future efforts should focus on direct-to-patient outreach and methods to identify patients without competing risks who are most likely to benefit from MASLD diagnosis and specific treatment.