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MASLD as Complication of Diabetes

Norbert Stefan1,2,3

  • 1Internal Medicine IV, Department of Diabetology, Endocrinology and Nephrology, University Hospital of Tübingen, Tübingen, Germany.

Diabetes
|June 6, 2026
PubMed

Insights

Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major liver disease linked to type 2 diabetes. Early screening and treatment, including specific medications, are crucial for managing MASLD in diabetic patients.

Area of Science:

  • Hepatology
  • Endocrinology
  • Metabolic Diseases

Background:

  • Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease globally.
  • MASLD is highly prevalent in individuals with type 2 diabetes (65% in adults, 37% in children).
  • MASLD shares pathogenic mechanisms with type 2 diabetes, including hyperglycemia, hyperinsulinemia, and hyperlipidemia.

Purpose of the Study:

  • To discuss the pathogenesis of MASLD and its relationship with type 2 diabetes.
  • To explore MASLD pathophysiology heterogeneity and risk stratification.
  • To advocate for specific pharmacotherapies in MASLD patients with type 2 diabetes.

Main Methods:

  • Review of major pathogenetic mechanisms linking MASLD and type 2 diabetes.
  • Discussion of MASLD pathophysiology and potential patient stratification clusters.
  • Analysis of hepato-, cardio-, and nephroprotective effects of specific drug classes.

Main Results:

  • MASLD pathogenesis is intricately linked to type 2 diabetes.
  • MASLD is increasingly viewed as a complication of diabetes.
  • Sodium-glucose cotransporter 2 inhibitors and GLP-1 receptor agonists show promise.

Conclusions:

  • MASLD requires integration into clinical diabetes management.
  • Further research into MASLD pathophysiology and risk stratification is needed.
  • SGLT2 inhibitors and GLP-1 RAs are recommended as first-line treatments for MASLD and type 2 diabetes.

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