A new consensus report from the American Diabetes Association (ADA) provides a comprehensive framework for screening and managing metabolic dysfunction-associated steatotic liver disease (MASLD) in people with diabetes and prediabetes. The guidelines aim to improve early diagnosis, treatment, and prevention of cirrhosis, which is often overlooked in diabetes management.
MASLD affects up to 70% of people with type 2 diabetes, particularly those with obesity, high blood pressure, or high triglycerides. The condition can lead to complications such as cirrhosis, liver cancer, and mortality. To address this issue, the ADA recommends that clinicians routinely screen patients with T2D or prediabetes for MASLD.
The guidelines recommend a staged screening approach using non-invasive tools such as the Fibrosis-4 (FIB-4) tool, which assesses age, liver enzymes, and platelet count. Clinicians should monitor patients with low-risk FIB-4 scores (less than 1.3) and provide optimized lifestyle advice. Those with higher risk scores will require referral to a liver specialist.
Treatment for MASLD includes lifestyle modifications such as nutrition plans, physical activity, and behavioral health support. Pharmacologic treatments, including semaglutide and tirzepatide, have shown benefit in treating metabolic dysfunction-associated steatohepatitis (MASH). However, these medications are expensive and may require alternative options.
The report also emphasizes the importance of considering alcohol intake when managing MASLD. Patients with moderate fibrosis should completely quit drinking. The guidelines aim to improve patient care by incorporating liver health into diabetes management, reducing stigma around the condition, and promoting better outcomes.
The ADA’s new guidelines provide a comprehensive framework for addressing MASLD in diabetes patients. By prioritizing early diagnosis, treatment, and prevention of cirrhosis, clinicians can help reduce the risk of complications associated with this often-overlooked condition.
Source: https://www.medscape.com/viewarticle/ada-issues-new-masld-guidelines-2025a1000esb