Diabetes and the Liver

Abstract

Type 2 Diabetes Mellitus (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD), formerly termed non-alcoholic fatty liver disease (NAFLD), are increasingly prevalent conditions that are closely associated. The shared pathophysiology of insulin resistance, chronic inflammation and increased lipid deposition mean there is a bidirectional relationship between the two conditions. MASLD is now a leading cause of cirrhosis and hepatocellular carcinoma (HCC) and has a high prevalence in patients with T2D. This review explores the synergy between MASLD and T2D while also outlining the diagnostic approach and management of T2D in the context of MASLD. Management involves lifestyle intervention, optimisation of cardiometabolic risk factors and multidisciplinary team involvement. We evaluate the use of antidiabetic medication such as SGLT-2 inhibitors and GLP-1 receptor agonists. Early identification of MASLD can help guide treatment and reduce the risk of progression to liver cirrhosis in high-risk patients. Copyright © 2025. Published by Elsevier Ltd.