At the 85th American Diabetes Association (ADA) Scientific Sessions, a clear message emerged: liver health is metabolic health, and diabetes providers must take the lead.
Opening a special symposium on MASLD, Dr. Mandeep Bajaj reminded attendees that while the liver has long been an overlooked organ in diabetes care, we can’t afford to ignore it any longer.
With the renaming of non-alcoholic fatty liver disease (NAFLD) to MASLD, clinicians across disciplines are being called to action. Why? Because MASLD is the most common chronic liver disease globally.
A Diagnosis Hiding in Plain Sight:
If you care for people with type 2 diabetes, you’re already on the MASLD front lines. Up to 80% of these patients have MASLD, 30% of whom will progress to metabolic-dysfunction associated steatohepatitis (MASH). Of those, about 20% of those will develop cirrhosis, often without symptoms until decompensation.
MASLD significantly increases the risk of cirrhosis, liver cancer, and death from cardiovascular disease, yet it remains widely underrecognized. A recent study by Lazarus et al. found that fewer than one in five adults and only about half of clinicians in four major U.S. cities had even heard of MASLD, highlighting a significant gap in public and provider recognition.
Fibrosis Risk Is Especially High in Endocrinology Settings:
Data presented by Dr. Kenneth Cusi highlighted findings from his research group’s study showing that significant liver fibrosis (≥ stage F2) was present in 22% of patients seen in endocrinology clinics and 12% in internal medicine clinics. These results underscore the critical opportunity for endocrinologists to lead in early MASLD detection and fibrosis risk stratification.
How to Implement FIB-4 in Primary and Endocrine Care
The FIB-4 score is calculated using age, AST, ALT, and platelet count — all typically available from routine lab work in diabetes care. It can be computed using an online calculator or integrated into the EHR.
A score under 1.3 indicates a low risk for advanced fibrosis and supports continued lifestyle and management of cardiometabolic risk factors. Scores between 1.3 and 2.67 fall into an indeterminate range and warrant further evaluation with tools like vibration-controlled transient elastography (VCTE). A score above 2.67 suggests a high risk for advanced fibrosis and should prompt referral to hepatology.
The 2025 ADA Consensus Statement recommends routine FIB-4 use for patients with type 2 diabetes — even when liver enzymes are normal — given MASLD’s often silent progression.
Team-Based Care Isn’t Optional, It’s Essential:
The session also emphasized that no one specialty can tackle MASLD alone. Liver care must center on the patient with lived experience but be bolstered by a collaborative care team, including providers from primary care, endocrinology, GI/hepatology, cardiology, behavioral health, nutrition, and metabolic surgery.
Bottom Line
Liver health belongs in every diabetes care conversation.
Sessions like this on the national stage are essential for raising awareness, aligning specialties, and accelerating the integration of liver health into mainstream diabetes care.
In 2025, let’s be the generation of providers that turns the tide. Let’s all be liver champions.
What Can You Do?
- Start integrating liver risk into routine diabetes visits
- Use simple tools like the FIB-4 score
- Refer early when fibrosis risk is elevated
- Advocate for lifestyle, nutrition, and behavioral interventions
- Educate peers and trainees; this is not just hepatology’s issue
Dr. Manolas has no conflicts of interest to report.
Image by ivector / Shutterstock
