Diabetes and liver cirrhosis: shared pathways and clinical implications - a narrative review

The global rise in type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) represents a critical and intertwined public health challenge. Both conditions share overlapping mechanisms, such as insulin resistance, lipid toxicity, chronic inflammation, and mitochondrial dysfunction, that drive disease progression and worsen outcomes. This review synthesizes emerging evidence on the bidirectional relationship between T2DM and MASLD, with a specific focus on underrecognized clinical intersections, including hepatogenous diabetes and the role of subclinical liver injury in diabetic patients. Unlike prior reviews, it emphasizes mechanistic links involving advanced glycation end products, cytokine dysregulation, and microvascular dysfunction, highlighting their implications for both hepatic and extrahepatic complications. We summarize epidemiological trends, outline gaps in current screening practices, and assess therapeutic strategies ranging from glycemic control and hepatoprotective antidiabetic agents to liver-directed interventions. Key takeaways for clinicians include the importance of early, integrated liver fibrosis assessment in diabetic care and the need for multidisciplinary approaches to reduce risks of cirrhosis, hepatocellular carcinoma, and mortality. By bridging pathophysiological insights with practical screening and treatment considerations, this review aims to guide more proactive and coordinated management of patients affected by T2DM and MASLD.