Related Experiment Video
Updated: Jan 11, 2026
Author Spotlight: Understanding Retinal Vessel Resilience and Disease Progression
Published on: January 12, 2024
Microvascular complications of type 2 diabetes with or without MASLD: the EPSOMIP study, a primary care cohort study
Martin Bergram1, Stergios Kechagias2, Fredrik Iredahl3,4
1Primary Health Care Center Ekholmen, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden. martin.bergram@liu.se.
Background:
Previous studies have shown inconsistent results for the microvascular complication risk in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD). In addition, many of these studies have been done in specialist care setting. We therefore aimed to explore the association between MASLD and chronic kidney disease, retinopathy, neuropathy, and diabetic foot ulcers in a primary care setting.
Methods:
Participants with type 2 diabetes were recruited in primary care. Hepatic triglyceride content was assessed using magnetic resonance imaging with liver proton density fat fraction (MASLD ≥ 5%) or vibration-controlled transient elastography with controlled attenuation parameter (MASLD ≥ 248 dB/m), and hepatic fibrosis was assessed using vibration-controlled transient elastography (advanced fibrosis ≥ 10 kPa). Data on chronic kidney disease, retinopathy, neuropathy, and diabetic foot ulcers were collected from medical records.
Results:
A total of 308 participants were included. The median duration of diabetes was 7 years (IQR 3-13). MASLD was present in 181 participants (58.8%). Of these, 161 (52.3%) showed no evidence of advanced fibrosis, while 20 (6.5%) were assessed as having advanced fibrosis. Neuropathy was present in 64 participants (20.8%), retinopathy in 60 (19.5%), chronic kidney disease in 59 (19.2%), and diabetic foot ulcers in 13 (4.2%). No significant differences in these complications were observed between participants with and without MASLD. However, participants with MASLD and a higher histopathological fibrosis stage had an increased risk of microvascular complications in our study.
Conclusions:
Participants with type 2 diabetes and concomitant MASLD recruited in primary care, did not have an increased risk of chronic kidney disease, neuropathy, or retinopathy, supporting previous findings of risk variation across different ethnicities and geographic locations.
Trial Registration:
Clinical trial number NCT03864510 (registration date 2019-02-12).
Insights
Type 2 diabetes patients with metabolic dysfunction-associated steatotic liver disease (MASLD) in primary care showed no increased risk of kidney disease, neuropathy, or retinopathy. However, advanced fibrosis with MASLD correlated with higher microvascular complication risk.
Area of Science:
- Endocrinology
- Hepatology
- Nephrology
- Ophthalmology
- Neurology
Background:
- Inconsistent findings exist regarding microvascular complication risk in type 2 diabetes patients with metabolic dysfunction-associated steatotic liver disease (MASLD).
- Many prior studies were conducted in specialist settings, necessitating primary care-based research.
- This study investigates MASLD's association with chronic kidney disease, retinopathy, neuropathy, and diabetic foot ulcers in a primary care context.
Purpose of the Study:
- To explore the association between MASLD and key microvascular complications in type 2 diabetes patients within a primary care setting.
- To clarify the risk of chronic kidney disease, retinopathy, neuropathy, and diabetic foot ulcers in patients with MASLD.
- To contribute to understanding MASLD's impact on diabetes complications across diverse healthcare environments.
Main Methods:
- Recruitment of type 2 diabetes participants from primary care settings.
- Assessment of hepatic triglyceride content via MRI-PDFF (MASLD ≥5%) or CAP (MASLD ≥248 dB/m).
- Evaluation of hepatic fibrosis using VCTE (advanced fibrosis ≥10 kPa) and collection of complication data from medical records.
Main Results:
- Out of 308 participants, 58.8% had MASLD; 6.5% had advanced fibrosis.
- No significant differences in neuropathy, retinopathy, or chronic kidney disease were found between MASLD and non-MASLD groups.
- MASLD with advanced fibrosis was linked to an increased risk of microvascular complications.
Conclusions:
- Type 2 diabetes patients with MASLD in primary care did not exhibit an elevated risk for chronic kidney disease, neuropathy, or retinopathy.
- Findings align with previous research suggesting risk variations across different populations and settings.
- The presence of advanced fibrosis in MASLD patients warrants further attention regarding microvascular complication risk.
Related Concept Videos
01:22Diabetes Mellitus: Type 2 and Gestational
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:22Diabetes Mellitus: Overview and Type I Subtype
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:15Diabetes: Management and Pharmacotherapy
Insulin remains the cornerstone of treatment for most patients with type 1 and many...