Screening for MASLD in patients with type 2 diabetes: is an early diagnosis a good diagnosis?

INTRODUCTION: Metabolic dysfunction associated steatotic liver disease (MASLD) is prevalent among patients with type 2 diabetes mellitus (T2DM) and is a growing cause of morbidity and mortality in Western countries. MASLD contributes to serious complications in individuals with T2DM, such as hepatocellular carcinoma, variceal bleeding, hepatic decompensation, and death. AREAS COVERED: Via a search of Pubmed, Google Scholar, and Embase (no date restrictions) this review explores the rationale for screening for MASLD in patients with T2DM and highlights the nutritional, pharmacological, and interventional advantages of early diagnosis. In particular, we examine the effectiveness of novel anti-fibrotic therapies, recently assessed in clinical trials. Alongside these potential benefits, we consider the financial implications for the healthcare system and possible adverse effects on patients. To contextualize the discussion, we compare MASLD screening with the established diabetic retinopathy screening program in England and reference the World Health Organization's principles for disease screening. EXPERT OPINION: Currently, there is insufficient evidence to support the implementation of a MASLD screening program for patients with T2DM. Key evidence gaps remain, particularly regarding: (1) the natural history of MASLD in patients with T2DM; (2) optimal timing and utilization of novel anti-fibrotic therapies; and (3) the impact of screening on major adverse liver outcomes compared to targeted testing approaches.