A new American Diabetes Association consensus statement provides guidance on screening, diagnosing, and managing metabolic dysfunction–associated steatotic liver disease.
A new consensus report from the American Diabetes Association provides a practice-oriented framework for screening and managing metabolic dysfunction–associated steatotic liver disease in people with diabetes and prediabetes.
the ADA released in 2023. It is intended for clinicians treating patients with diabetes — primarily type 2 diabetes — but also type 1 diabetes with obesity and prediabetes. Topics covered include the rationale for the recent change in terminology, epidemiology, fibrosis risk stratification, monitoring, treatment, and referral guidance, with interprofessional team management emphasized throughout. “This will provide primary care doctors and anyone taking care of people with diabetes the tools to diagnose early and guide therapy…to prevent cirrhosis, and refer to the hepatologist as needed for additional therapy and monitoring,” lead author Kenneth Cusi, MD, professor of medicine at the Division of Endocrinology, Diabetes & Metabolism in the Department of Medicine at the University of Florida, Gainesville, Florida, toldThe guidelines recommend that clinicians routinely screen people with T2D or prediabetes for MASLD. “We explain that the liver should be incorporated into our management in the same way we do for chronic kidney disease, eye disease, and nerve disease as an end-organ damage that is particularly affected by diabetes,” Cusi said. In the United States, at least 70% of people with T2D have MASLD, about half of whom have the more progressive form termed metabolic dysfunction–associated steatohepatitis . About 1 in 5 with T2D have advanced liver fibrosis. The presence of MASH increases the risks for complications including cirrhosis, hepatocellular carcinoma, and overall mortality, according to the new consensus report. Liver disease has not been a focus of diabetes management until recently, Cusi noted. “We didn’t think about it. The epidemic of obesity, and with that, of diabetes, is driving this liver disease. The obesity epidemic has had a big worsening since the 1990s, so this damage in the past 20 or 30 years is just now becoming evident in the liver.” for SLD, which was officially changed in 2023 to remove the words “fatty” and “alcoholic.” Now, MASLD is defined as the presence of SLD with at least one metabolic risk factor such as obesity, hypertension, prediabetes, high triglycerides, low high-density lipoprotein cholesterol, or T2D, with minimal or no alcohol consumption , most commonly with transient elastography. If that is unavailable, an alternative is the noninvasive If the LSM is< 8.0 kPa or ELF is< 7.7, the fibrosis risk is low and routine management can continue with repeat testing in 1-2 years. But if higher, hepatology referral is recommended.The report details lifestyle modification for MASLD, including nutrition plans; physical activity; behavioral health; and the role of diabetes self-management, education and support. The role of obesity treatment in people with MASLD, both metabolic surgery and pharmacotherapy, is also discussed at length.in early 2024 for the treatment of MASH with fibrosis stages F2 and F3, but is extremely expensive at about $50,000 a year, Cusi noted. An older, generic glucose-lowering drug,The document also includes a section on alcohol intake, which complicates the MASLD picture, Cusi noted. “We think that this is going to help doctors to consider alcohol, which is often overlooked and under-reported. If patients have moderate fibrosis, they should completely quit alcohol.” Cusi has received research support from Boehringer Ingelheim, Echosens, Inventiva, Labcorp, and Perspectum, and has served as a consultant for Aligos Therapeutics, Arrowhead, AstraZeneca, 89bio, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Novo Nordisk, ProSciento, Sagimet Biosciences, Siemens USA, Zealand Pharma, and Terns Pharmaceuticals. Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in the Washington Post, NPR’s Shots blog, and Diatribe. She is on X @MiriamETucker and BlueSky @miriametucker.bsky.social.All material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
Gallbladder Disease Nonalcoholic Fatty Liver Disease NAFLD Non-Alcoholic Fatty Liver Disease Non-Alcoholic Fatty Liver Disease (NAFLD) MAFLD Metabolic Dysfunction-Associated Fatty Liver Dise Metabolic Associated Fatty Liver Disease Metabolic Syndrome Liver Disease Hepatic Impairment
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