Misra Anoop, Kumar Ashish, Kuchay Mohammad Shafi, Ghosh Amerta, Gulati Seema, Choudhary Narendra Singh, Dutta Deep, Sharma Praveen, Vikram Naval K
Fortis CDOC Center of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, India; National Diabetes Obesity and Cholesterol Foundation (N-DOC), New Delhi, India; Diabetes Foundation India, New Delhi, India.
Gastroenterology & Hepatology,Sir Ganga Ram Hospital, Rajinder Nagar New Delhi, India.
Diabetes Metab Syndr. 2025 Mar;19(3):103209. doi: 10.1016/j.dsx.2025.103209. Epub 2025 Mar 5.
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a critical health concern among Asian Indians with type 2 diabetes (T2D), characterized by particularly high prevalence and risk of progression. The need for specific guidelines addressing this dual epidemic is vital, given the adverse metabolic characteristics of Asian Indians.
A comprehensive literature review was conducted across major databases (PubMed, Embase, Cochrane Library, and Google Scholar) up to December 2024. For topics lacking robust evidence, a modified Delphi survey was conducted among endocrinologists, diabetologists, and gastroenterologists across India. Consensus statements were developed through a systematic process involving a core task force of nine experts.
The consensus provides evidence-based recommendations for the screening, diagnosis, and management of MASLD in individuals with T2D. Key findings include mandatory screening for all individuals with T2D, with particular attention to those exhibiting high-risk features such as metabolic syndrome and obesity. Non-invasive tools, such as FIB-4 or vibration-controlled transient elastography, are recommended for fibrosis assessment. Management strategies encompass lifestyle modifications, pharmacological interventions, and surgical options when appropriate. The consensus also addresses specific considerations for hepatocellular carcinoma surveillance in patients with advanced fibrosis and compensated cirrhosis.
These consensus guidelines offer the first tailored, evidence-based recommendations for the management of MASLD in Asian Indians with T2D, addressing the unique metabolic and clinical characteristics of this population. The guidelines emphasize proactive screening, regular monitoring, and early intervention, along with a comprehensive, multi-modal treatment approach to optimize outcomes in this high-risk group.
代谢功能障碍相关脂肪性肝病（MASLD）已成为亚洲印度裔2型糖尿病（T2D）患者的一个关键健康问题，其特点是患病率特别高且进展风险大。鉴于亚洲印度裔不利的代谢特征，制定针对这两种流行病的具体指南至关重要。
截至2024年12月，对主要数据库（PubMed、Embase、Cochrane图书馆和谷歌学术）进行了全面的文献综述。对于缺乏有力证据的主题，在印度各地的内分泌学家、糖尿病学家和胃肠病学家中进行了改良的德尔菲调查。通过一个由九名专家组成的核心特别工作组参与的系统过程制定了共识声明。
该共识为T2D患者中MASLD的筛查、诊断和管理提供了基于证据的建议。主要发现包括对所有T2D患者进行强制性筛查，尤其要关注那些表现出代谢综合征和肥胖等高风险特征的患者。建议使用FIB-4或振动控制瞬时弹性成像等非侵入性工具进行纤维化评估。管理策略包括生活方式改变、药物干预以及在适当情况下的手术选择。该共识还涉及晚期纤维化和代偿期肝硬化患者肝细胞癌监测的具体注意事项。
这些共识指南为亚洲印度裔T2D患者中MASLD的管理提供了首个量身定制的、基于证据的建议，解决了该人群独特的代谢和临床特征。这些指南强调积极筛查、定期监测和早期干预，以及采用全面的多模式治疗方法来优化这个高危群体的治疗效果。
