Primary Care Approaches to MASLD in Type 2 Diabetes

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in type 2 diabetes. Due to its asymptomatic nature, MASLD has been largely underdiagnosed despite its systemic health effects and impact on patients’ quality of life. This article summarizes MASLD, screening strategies, and treatment options in patients with type 2 diabetes. The resources used for this article were obtained through a keyword-based search of PubMed, ScienceDirect, and Cochrane Library. MASLD screening starts with identifying patients with high-risk liver and metabolic conditions, like type 2 diabetes, without a substantial alcohol consumption history. First line screening is noninvasive and involves the fibrosis-4 index. For those with scores at or above 1.3, secondary screening is done with transient elastography or an enhanced liver fibrosis test. If patients are determined to be at a high risk based on the secondary screening, they are referred to a hematologist for advanced treatment. This involves magnetic resonance elastography with proton density fat fraction or, less commonly, liver biopsy. While lifestyle modifications are the first-line treatment, pharmacological options are available and stratified based on concurrent metabolic conditions. Glucagon-like peptide-1 agonists are the current standard of care, especially for patients interested in weight loss. However, pioglitazone and sodium-glucose cotransporter 2 inhibitors can also be considered for those with type 2 diabetes. Plus, resmetirom and semaglutide have been approved for metabolic dysfunction-associated steatohepatitis in those with moderate fibrosis. New medications and combination treatments are on the horizon to address interconnected cardiovascular, renal, and hepatic conditions.