Nwoguh Chinonso, Byrne Christopher D, Reinson Tina, Buchanan Ryan M
Population Health Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Department of Hepatology, University Hospital Southampton, Southampton, UK.
Expert Rev Gastroenterol Hepatol. 2025 Sep;19(9):941-951. doi: 10.1080/17474124.2025.2546597. Epub 2025 Aug 19.
Metabolic dysfunction associated steatotic liver disease (MASLD) is prevalent among patients with type 2 diabetes mellitus (T2DM) and is a growing cause of morbidity and mortality in Western countries. MASLD contributes to serious complications in individuals with T2DM, such as hepatocellular carcinoma, variceal bleeding, hepatic decompensation, and death.
Via a search of Pubmed, Google Scholar, and Embase (no date restrictions) this review explores the rationale for screening for MASLD in patients with T2DM and highlights the nutritional, pharmacological, and interventional advantages of early diagnosis. In particular, we examine the effectiveness of novel anti-fibrotic therapies, recently assessed in clinical trials. Alongside these potential benefits, we consider the financial implications for the healthcare system and possible adverse effects on patients. To contextualize the discussion, we compare MASLD screening with the established diabetic retinopathy screening program in England and reference the World Health Organization's principles for disease screening.
Currently, there is insufficient evidence to support the implementation of a MASLD screening program for patients with T2DM. Key evidence gaps remain, particularly regarding: (1) the natural history of MASLD in patients with T2DM; (2) optimal timing and utilization of novel anti-fibrotic therapies; and (3) the impact of screening on major adverse liver outcomes compared to targeted testing approaches.
代谢功能障碍相关脂肪性肝病（MASLD）在2型糖尿病（T2DM）患者中普遍存在，并且在西方国家正成为发病率和死亡率上升的一个原因。MASLD会导致T2DM患者出现严重并发症，如肝细胞癌、静脉曲张出血、肝失代偿和死亡。
通过检索PubMed、谷歌学术和Embase（无日期限制），本综述探讨了对T2DM患者进行MASLD筛查的基本原理，并强调了早期诊断在营养、药物和干预方面的优势。特别是，我们研究了最近在临床试验中评估的新型抗纤维化疗法的有效性。除了这些潜在益处，我们还考虑了对医疗保健系统的财务影响以及对患者可能产生的不良影响。为了使讨论更具背景，我们将MASLD筛查与英国既定的糖尿病视网膜病变筛查计划进行比较，并参考世界卫生组织的疾病筛查原则。
目前，没有足够的证据支持对T2DM患者实施MASLD筛查计划。关键证据空白仍然存在，特别是关于：（1）T2DM患者中MASLD的自然病史；（2）新型抗纤维化疗法的最佳时机和应用；以及（3）与针对性检测方法相比，筛查对主要肝脏不良结局的影响。
