Hepatic involvement in children with diabetes: Pathophysiology, clinical manifestations, and current management

Diabetes is a chronic disease characterized by hyperglycemia resulting from insulin deficiency or resistance to insulin action. Its onset may result from polygenic or monogenic mechanisms. The liver plays a central role in glucose metabolism and can be affected by various conditions. In poorly controlled type 1 diabetes, glycogenic liver disease presents with hepatomegaly and elevated liver enzymes, which is reversible with good metabolic control. Autoimmune hepatitis may coexist with type 1 diabetes due to shared immunological mechanisms or may develop during treatment with corticosteroids. In type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD) is common and can progress to severe forms. Monogenic forms may be associated with structural abnormalities of the liver and biliary tract. Early recognition of liver involvement and a multidisciplinary approach are essential for preventing long-term complications.