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Key takeaways:
Adults with kind 2 diabetes or prediabetes plus cardiometabolic danger components must be screened for MASLD.
Increased bodily exercise, dietary change and improved sleep could decrease MASLD danger.
Diabetes care and schooling specialists ought to determine individuals with diabetes in danger for metabolic dysfunction-associated steatotic liver illness and intervene early in illness development, in keeping with two audio system.
Metabolic dysfunction-associated steatotic liver illness (MASLD) is a standard comorbidity for individuals with diabetes. Susan Cornell, PharmD, CDCES, FAPhA, FADCES, professor emeritus at Midwestern University College of Pharmacy; diabetes care and schooling specialist and advisor at Bolingbrook Christian Health Center and Will Grundy Medical Clinic; and a Healio | Endocrine Today Editorial Board Member, mentioned roughly 70% of individuals with kind 2 diabetes and 20% of these with kind 1 diabetes have MASLD. Additionally, Cornell mentioned, about half of individuals with diabetes and MASLD will go on to develop metabolic dysfunction-associated steatohepatitis (MASH).
During a chat on the Association of Diabetes Care & Education Specialists annual assembly, Cornell and Kathy Warwick, RDN, LDN, CDCES, diabetes care and schooling specialist and proprietor of Professional Nutrition Consultants LLC, mentioned the function diabetes care and schooling specialists can play in managing liver well being for individuals with diabetes.
“The liver now needs to be in our repertoire of screening events,” Cornell mentioned throughout a presentation. “Always remember lifestyle [intervention] is the cornerstone. Drugs are always added to lifestyle.”
There are a number of causes screening for MASLD and MASH is so troublesome, in keeping with Warwick. She mentioned the illness is usually asymptomatic for sufferers, although they might be experiencing degradations in health-related high quality of life. Warwick mentioned different limitations are a stigma surrounding perceived alcohol use, a MASLD prognosis being downplayed by sufferers, or any signs being attributed to different cardiometabolic issues.
Additionally, Warwick mentioned, there’s a lack of understanding about MASLD amongst healthcare professionals, an absence of normal tips for treating the illness, and solely two FDA-approved drugs for the situation: resmetirom (Rezdiffra, Madrigal Pharmaceuticals) and semaglutide (Wegovy, Novo Nordisk).
“A lot of physicians don’t really know what to do with that diagnosis or what follows next,” Warwick mentioned. “The thing that’s scary is that they give conflicting messages, the healthcare professionals, and then they are not even sure about the terminology. I see physicians still sending people to me and calling it nonalcoholic fatty liver disease.”
Screening and life-style intervention
Warwick reviewed suggestions for MASLD screening from the American Diabetes Association 2026 Standards of Care. She mentioned individuals with prediabetes or kind 2 diabetes with weight problems, cardiometabolic danger components or established heart problems must be screened with the Fibrosis-4 (FIB-4) index. Screening also needs to happen amongst anybody with kind 2 diabetes and an alanine aminotransferase stage of greater than 30 U/L. Warwick mentioned anybody who has a FIB-4 index of 1.3 or higher ought to bear extra danger evaluation, and adults at elevated danger must be referred to a gastroenterologist or hepatologist for additional analysis and administration.
Warwick mentioned life-style intervention is essential for adults in danger for MASLD simply as it’s for these in danger for different cardiometabolic illnesses. Some suggestions embody a eating regimen with decreased caloric consumption, extra plant-based meals, growing consumption of fiber, prebiotics and wholesome fats sources and limiting saturated fats, added sugars, alcohol, processed meats and different processed meals. Diabetes care and schooling specialists also needs to have individuals with diabetes improve bodily exercise, guarantee they’re getting high-quality sleep, handle any psychological well being issues and eradicate nicotine publicity.
“It’s important to note that we focus so much on weight when, in fact, if they just reduce their calorie intake and they just increase their physical activity a little bit, you see improvement in [liver fat],” Warwick mentioned. “We don’t need to set impossible goals for those clients. We just need to see if we can get them moving a little bit and we just need to make them aware of the fact that if they just reduce their caloric intake a bit, they can see improvement.”
Medications for MASLD
Cornell mentioned there are three targets of pharmacotherapy for adults with kind 2 diabetes at excessive danger for MASLD:
cardiorenal danger discount;
attaining and sustaining glycemic and weight targets; and
mitigating danger for MASLD or MASH.
Among drugs that could possibly be prescribed in these sufferers are incretin-based therapies comparable to GLP-1 receptor agonists or GLP-1/glucose-dependent insulinotropic polypeptide (GIP) twin agonists. Semaglutide is the one incretin-based drug at present permitted for MASLD, however healthcare professionals shouldn’t rule out different therapies, Cornell mentioned.
“There are studies ongoing with other GLP-1s, and even in the Obesity Association guidelines, they’re saying that there is potential benefit with liraglutide (Saxenda/Victoza, Novo Nordisk) and tirzepatide (Mounjaro/Zepbound, Eli Lilly),” Cornell mentioned. “One of the things we want to think about from a medication standpoint is double dipping. Can we treat more than one condition with one drug?”
Other choices embody pioglitazone, which might scale back hepatic steatosis and irritation and improve insulin uptake in peripheral tissue; SGLT2 inhibitors, which might lower hepatic fats and enhance cardiometabolic parameters; and resmetirom, which might enhance lipid metabolism and decrease fats accumulation and liver irritation.
Cornell mentioned sufferers shouldn’t be handled with drugs alone, and that medication have to be used together with life-style intervention.
“Medicine is always added to lifestyle,” Cornell mentioned. “Because [patients] are so focused on glucose, they forget about the benefits to the heart, the kidneys and the liver. [We are] just reminding them that there’s more involved than your sugar.”