Combine lifestyle change with drugs to prevent MASLD in people with type 2 diabetes

# Why MASLD matters for people with diabetes Metabolic dysfunction-associated steatotic liver disease (MASLD) is a frequent, often silent, comorbidity in people with diabetes. Speakers at the Association of Diabetes Care & Education Specialists meeting urged diabetes care and education specialists to routinely identify patients at risk and intervene early to prevent progression to metabolic dysfunction-associated steatohepatitis (MASH).

# How common and who is at risk Estimates cited in the presentation put MASLD prevalence at about 70% among people with type 2 diabetes and about 20% among people with type 1 diabetes. Around half of people with diabetes who have MASLD may go on to develop MASH. Because MASLD is frequently asymptomatic and can be downplayed or misattributed, proactive screening is necessary for detection.

# Practical screening approach Follow the American Diabetes Association 2026 Standards of Care recommendations described by the speakers:

• Screen people with prediabetes or type 2 diabetes who also have obesity, cardiometabolic risk factors, or established cardiovascular disease.
• Use the Fibrosis-4 (FIB-4) index as an initial risk stratification tool.
• If alanine aminotransferase (ALT) is > 30 U/L in an adult with type 2 diabetes, proceed with screening.
• Refer adults with a FIB-4 index of 1.3 or greater to gastroenterology or hepatology for further assessment and management.

# Lifestyle interventions that reduce liver fat Lifestyle intervention is described as the cornerstone of care. Practical, achievable changes include:

• Reduce overall calorie intake without setting unrealistic weight targets.
• Increase plant-based foods and dietary fiber, and include prebiotics and healthy fat sources.
• Limit saturated fat, added sugars, processed meats and highly processed foods.
• Increase physical activity incrementally rather than relying on large, immediate goals.
• Improve sleep quality, screen and treat mental health concerns, and eliminate nicotine exposure.

Speakers emphasized that modest calorie reduction and small increases in activity can meaningfully lower liver fat even without large weight loss.

# When to consider medication Drugs are added to, not substituted for, lifestyle measures. The presentation noted two FDA-approved medications for MASLD: resmetirom (Rezdiffra) and semaglutide (Wegovy). Clinicians should consider medication in the context of a patient's overall risk, liver assessment results, and after referral when appropriate.

# Barriers clinicians should anticipate

# Role of diabetes care and education specialists Diabetes care and education specialists can lead screening efforts, deliver practical lifestyle counseling focused on small, sustainable changes, coordinate referrals for elevated FIB-4, and support patients in medication discussions with prescribers. Making liver health part of routine diabetes care helps catch MASLD earlier and reduce progression to MASH.