• Arshid Rafiq
• Vinay Shaw
• Saurab Singhal
• Rutba Maqbool
• Summairah Mushtaq

Metabolic dysfunction associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), affects an estimated 55–70% of adults with type 2 diabetes and is now a leading contributor to cirrhosis and liver transplantation in the United States. The relationship between type 2 diabetes and MASLD is bidirectional: insulin resistance, adipose-tissue dysfunction, and genetic susceptibility drive hepatic steatosis and its progression to metabolic dysfunction–associated steatohepatitis (MASH) and fibrosis, while the resulting hepatokine, inflammatory, and gut-microbial milieu worsens glycemic control and cardiovascular and renal risk. Recognizing this burden, the American Diabetes Association (ADA) Standards of Care in Diabetes recommends systematic risk stratification for advanced fibrosis in all adults with type 2 diabetes or prediabetes using the Fibrosis-4 (FIB-4) index, with reflex noninvasive testing—vibration-controlled transient elastography or the enhanced liver fibrosis test—for indeterminate or high-risk scores, and hepatology referral above defined thresholds. This review synthesizes current evidence on the epidemiology, genetics, and bidirectional pathophysiology linking type 2 diabetes and MASLD/MASH; the strengths and limitations of available noninvasive diagnostic tools; the ADA-endorsed screening and referral algorithm; and the rapidly evolving pharmacologic landscape, including pioglitazone, GLP-1 receptor agonists, the dual GIP/GLP-1 agonist tirzepatide, and the two agents now approved specifically for MASH with fibrosis, resmetirom and semaglutide. Considerations for special populations—type 1 diabetes, chronic kidney disease, older adults, and adolescents transitioning to adult care—and for equitable, system-level implementation are also addressed. Early, systematic identification of at-risk patients, rather than reliance on liver enzymes alone, combined with therapy selected to address glycemic, weight, cardiovascular, and hepatic outcomes concurrently, is central to preventing cirrhosis, hepatocellular carcinoma, and premature death in this population.

MASLD,NAFLD,MASH,ADA,GLP1 Receptor

"Metabolic Dysfunction Associated Steatotic Liver Disease in Type 2 Diabetes: A Narrative Review", International Journal of Emerging Technologies and Innovative Research (www.jetir.org), ISSN:2349-5162, Vol.13, Issue 9, page no.d253-d267, September-2026, Available :http://www.jetir.org/papers/JETIR2609328.pdf

"Metabolic Dysfunction Associated Steatotic Liver Disease in Type 2 Diabetes: A Narrative Review", International Journal of Emerging Technologies and Innovative Research (www.jetir.org | UGC and issn Approved), ISSN:2349-5162, Vol.13, Issue 9, page no. ppd253-d267, September-2026, Available at : http://www.jetir.org/papers/JETIR2609328.pdf