Management of patients with type 2 diabetes and MASLD: An overview and joint statement

Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) are two highly prevalent diseases with rapidly growing incidences worldwide. They are frequently associated due to their shared pathophysiology and their bidirectional influence. MASLD-related liver fibrosis is a major driver of hepatic complications and is associated with increased risk of extrahepatic complications, such as cardiovascular and renal diseases in patients with T2D. In this setting, systematic screening for advanced fibrosis related to MASLD is now unanimously recommended for patients with T2D, due to its high prevalence and specific therapeutic management. The French Association for the Study of the Liver (AFEF) and the Francophone Diabetes Society (SFD) convened a group of experts to summarize the current knowledge on MASLD screening and therapeutic management in patients with T2D and thus provide a roadmap to healthcare professionals, especially diabetologists or primary care physicians. Our focus will be on the particularities of dietary and behavioral management, pharmacological treatment of T2D, and bariatric procedures in cases of MASLD. Our goal is to provide clinical guidance for adapting drug therapy in the presence of significant fibrosis in order to slow the progression of liver disease and reduce the risk of associated clinical events.