BACKGROUND The rising comorbidity of T2DM and MASLD, driven by insulin resistance (IR), underscores the need for effective interventions. This study evaluated the impact of a 3-month structured lifestyle intervention on hepatic steatosis, IR, and metabolic parameters in patients with T2DM-MASLD. MATERIAL AND METHODS Thirty-seven patients received personalized low-calorie diets and exercise regimens. Hepatic fat was quantified via MRI-PDFF, with biochemical parameters and HOMA-IR assessed at baseline and after intervention. Participants were stratified into compliant (³5% weight loss, n=26) and non-compliant groups (<5%, n=11). RESULTS Both groups had significant reductions in BMI and hepatic fat fraction (p<0.05), with greater improvements in the compliant group. The compliant group had significant improvements in TBIL, AST, ALT, HDL-c, and HOMA-IR (a significant 31.2% reduction in HOMA-IR [p<0.001]). Multivariate analysis revealed that MRI-PDFF explained 42.5% of hepatic fat variability. CONCLUSIONS A 5% weight loss threshold effectively ameliorates hepatic steatosis and IR, reinforcing lifestyle modification as a cornerstone in T2DM-MASLD management. Integration of digital monitoring tools enhances compliance, addressing a critical barrier in real-world implementation.