endocrine and metabolic disorders
Complications of Diabetes Mellitus
Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD)
 Metabolic Dysfunction–Associated Liver Disease (MASLD) (MASLD, formerly nonalcoholic fatty liver disease [NAFLD]), is increasingly common and represents an important comorbidity of type 2 diabetes. Some studies have found that over half of patients with type 2 diabetes have MASLD ( Diagnosis of MASLD requires evidence of hepatic steatosis by imaging or histology, and a lack of other causes of fat accumulation (such as alcohol consumption or medications that cause fat accumulation) ( MASLD references ). MASLD occurs when there is Individuals with type 2 diabetes can be screened for fibrosis by calculating the fibrosis 4 index for liver fibrosis (FIB-4 index) from age, aminotransferase levels, and platelet count. Further testing to look for fibrosis, with transient elastography or fibrosis blood markers can be performed if the FIB-4 score shows indeterminate or high risk of fibrosis. has been shown to slow progression of fibrosis ( MASLD references , 1.Lee YH, Cho Y, Lee BW, et al. Nonalcoholic Fatty Liver Disease in Diabetes. Part I: Epidemiology and Diagnosis [published correction appears inDiabetes Metab J2019 Oct;43(5):731].Diabetes Metab J2019;43(1):31-45. doi:10.4093/dmj.2019.0011 2.Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD).Endocr Pract2022;28(5):528-562. doi:10.1016/j.eprac.2022.03.010 3.Armstrong MJ, Gaunt P, Aithal GP, et al.Liraglutidesafety and efficacy in patients with non-alcoholic steatohepatitis (LEAN): a multicentre, double-blind, randomised, placebo-controlled phase 2 study.Lancet2016;387(10019):679-690. doi:10.1016/S0140-6736(15)00803-X 4.Belfort R, Harrison SA, Brown K, et al. A placebo-controlled trial ofpioglitazonein subjects with nonalcoholic steatohepatitis.N Engl J Med2006;355(22):2297-2307. doi:10.1056/NEJMoa060326 5.Cusi K, Orsak B, Bril F, et al. Long-TermPioglitazoneTreatment for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes Mellitus: A Randomized Trial.Ann Intern Med2016;165(5):305-315. doi:10.7326/M15-1774 6.Newsome PN, Buchholtz K, Cusi K, et al. A Placebo-Controlled Trial of SubcutaneousSemaglutidein Nonalcoholic Steatohepatitis.N Engl J Med2021;384(12):1113-1124. doi:10.1056/NEJMoa2028395 7.Patel Chavez C, Cusi K, Kadiyala S. The Emerging Role ofGlucagon-like Peptide-1 Receptor Agonists for the Management of NAFLD.J Clin Endocrinol Metab2022;107(1):29-38. doi:10.1210/clinem/dgab578 