Two-Thirds of People with Diabetes Have Fatty Liver—and Most Don't Know It

Over 70% of individuals with type 2 diabetes have metabolic dysfunction–associated steatotic liver disease (MASLD), previously referred to as fatty liver disease. But it is still not well recognized—despite being one of the most prevalent and deadly complications of diabetes. The patient consensus report of the American Diabetes Association demands action now: early screening, risk stratification, and coordinated care to avert its fatal outcomes.

MASLD is diagnosed when there is excess fat in the liver with metabolic conditions such as obesity or elevated blood sugar–and not due to alcohol. Almost all of individuals with type 2 diabetes already have evidence of metabolic dysfunction–associated steatohepatitis (MASH), and approximately one in five also have advanced fibrosis, putting them at miraculously increased risk for cirrhosis, liver cancer, and liver- related mortality

It also increases the risk of heart disease, kidney disease, other cancers, and markedly decreases quality of life

Since MASLD tends to be asymptomatic, the ADA suggests proactive screening for liver fibrosis in every patient with type 2 diabetes or prediabetes, particularly for overweight individuals. Diagnosis must be based on non-invasive tests and imaging, along with judicious clinical assessment

The report highlights a multi-faceted approach to management: diet and exercise-induced weight loss, GLP-1 agonist, SGLT-2 inhibitor, and pioglitazone use, and targeted vitamin E or resmetirom use where appropriate

Notably, MASLD treatment must be integrated—diabetes physicians, liver specialists, dieticians, and primary care physicians collaborating to identify early risk and customize long-term follow-up.

Fatty liver is no silent bystander—it's a metabolic warning sign that usually precedes. Click here to discover why screening and early intervention for MASLD might be a lifeline for millions of people living with diabetes.