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©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
Metabolic dysfunction-associated steatotic liver disease and type 2 diabetes: Pathophysiology, diagnosis, and emerging therapeutic strategies
Mithil Gowda Suresh, Safia Mohamed, Harinivaas S Geetha, Sushmita Prabhu, Nitin Trivedi, Zhu C Ng, Priyal D Mehta, Ajit S Brar, Aalam Sohal, Manjeet K Goyal, Juniali Hatwal, Akash Batta
Mithil Gowda Suresh, Harinivaas S Geetha, Sushmita Prabhu, Nitin Trivedi, Zhu C Ng, Priyal D Mehta, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Safia Mohamed, Department of Medicine and Surgery, University of Massachusetts Chan Medical School-Baystate Medical Center, Springfield, MA 01199, United States
Ajit S Brar, Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI 48503, United States
Aalam Sohal, Department of Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
Manjeet K Goyal, Department of Internal Medicine, Cleveland Clinic Akron General Hospital, Akron, OH 110029, United States
Juniali Hatwal, Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
Akash Batta, Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Author contributions: Suresh MG and Mohamed S conceptualized and designed the study; Suresh MG, Geetha HS, Prabhu S, Trivedi N, Ng ZC, Mehta PD, Mohamed S, Brar AS, Hatwal J and Sohal A conducted the literature review, interpreted data, created artwork, and drafted the original manuscript; Suresh MG, Goyal MK and Batta A supervised the study and made critical revisions, each author meets the criteria for authorship and accepts responsibility for the integrity of the content; all authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Akash Batta, MD, Associate Professor, Department of Cardiology, Dayanand Medical College and Hospital, Tagore Nagar, Civil Lines, Ludhiana 141001, Punjab, India.
akashbatta02@gmail.com
Received: August 18, 2025
Revised: September 14, 2025
Accepted: December 25, 2025
Published online: February 15, 2026
Processing time: 174 Days and 15.4 Hours
Metabolic dysfunction-associated steatotic liver disease (MASLD), the updated terminology for fatty liver disease linked to metabolic dysfunction, is highly prevalent among individuals with type 2 diabetes mellitus (T2DM). MASLD affects a majority of patients with T2DM and markedly increases the risk of fibrosis, cirrhosis, hepatocellular carcinoma, and cardiovascular mortality. The pathogenesis in diabetic populations reflects a convergence of insulin resistance, dyslipidemia, mitochondrial dysfunction, chronic inflammation, and genetic predisposition. Advances in non-invasive diagnostics, including elastography and serum biomarkers, enable earlier identification and staging of disease, though limitations remain in diabetic cohorts. Lifestyle modification is the cornerstone of therapy, yet emerging pharmacotherapies are reshaping the therapeutic landscape. Antidiabetic agents such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and pioglitazone show hepatic benefits beyond glycemic control, while novel agents and combination regimens are under active evaluation. This narrative review synthesizes current evidence on epidemiology, mechanisms, diagnostics, and therapeutics of MASLD in T2DM, and highlights future directions in precision medicine. Integration of multidisciplinary care is essential to address this converging epidemic.
Core Tip: Metabolic dysfunction-associated steatotic liver disease is highly prevalent among patients with type 2 diabetes mellitus, amplifying risks of fibrosis, cirrhosis, hepatocellular carcinoma, and cardiovascular disease. The pathogenesis reflects overlapping mechanisms of insulin resistance, dyslipidemia, inflammation, and genetic predisposition. This narrative review integrates updated evidence on epidemiology, diagnostics, and therapeutics, emphasizing the roles of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, and emerging agents. A multidisciplinary, personalized approach remains essential to reduce the burden of this increasingly recognized disease spectrum.
