ADA consensus report calls for MASLD, liver fibrosis screening in type 2 diabetes
A two-tier system for stratifying patients based on their risk of metabolic dysfunction-associated steatotic liver disease (MASLD) was recommended by the American Diabetes Association (ADA).
The American Diabetes Association (ADA) called for more awareness about the health risks associated with metabolic dysfunction-associated steatotic liver disease (MASLD) and broad adoption of screening for liver fibrosis in patients with type 2 diabetes in a recent consensus report.
MASLD, previously referred to as nonalcoholic fatty liver disease, is defined by the presence of steatotic (fatty) liver disease and one metabolic risk factor—overweight, obesity, hypertension, prediabetes, type 2 diabetes, high triglycerides, or low high-density lipoprotein cholesterol—with negligible alcohol intake.
The report, published May 28 by Diabetes Care, noted that clinicians can engage in earlier identification and proper management to prevent the progression of fibrosis to cirrhosis in people with prediabetes and type 2 diabetes, as they do for microvascular complications or cardiovascular disease, but that liver health has not traditionally been at the forefront of their attention. MASLD is also associated with increased risk of hepatocellular carcinoma as well as extrahepatic malignancies and cardiovascular disease, the report noted.
The ADA called for patients with prediabetes or type 2 diabetes to be risk stratified with a two-tier approach. The first step is to calculate the fibrosis-4 (FIB-4) index using common laboratory tests (patient age, aspartate aminotransferase level, alanine aminotransferase level, and platelet count). A FIB-4 score less than 1.3 can be used to exclude advanced fibrosis. Patients with type 2 diabetes and a FIB-4 score greater than 2.67 can be directly referred to gastroenterologists and hepatologists for assessment of at-risk metabolic dysfunction-associated steatohepatitis (MASH) with clinically significant liver fibrosis or cirrhosis. Vibration-controlled transient elastography liver stiffness measurement is the second tier in the process, with a cutoff of 8.0 kPa ruling out advanced fibrosis.
“More awareness about the health risks associated with MASLD and broad adoption of screening for liver fibrosis as a new standard of care hold promise for a future without cirrhosis for people with prediabetes and type 2 diabetes,” the report stated. Management of MASLD should involve a team of primary care physicians, endocrinologists, nurses, dieticians, behavioral health specialists, obesity management teams, and other medical specialists. A comprehensive care plan includes lifestyle modification, weight management, and pharmacological treatment aimed at preventing cardiovascular disease and MASH cirrhosis.
The report noted that one in five people with type 2 diabetes have clinically significant fibrosis and are at high risk of developing cirrhosis and that MASLD is one of the most common causes of liver transplantation in the U.S. “Health care professionals must recognize that an early diagnosis is possible by using noninvasive tests (NITs) to stratify people for their risk of developing cirrhosis. A timely diagnosis can encourage the adoption of healthier lifestyle habits or the initiation of pharmacological treatments for obesity and type 2 diabetes, which can prevent disease progression and, ultimately, cirrhosis,” it said.