MASLD–T2D Overlap Requires Early Detection and Integrated Care

A growing body of medical research is highlighting the urgent need for earlier detection and integrated care for patients living with both metabolic dysfunction–associated steatotic liver disease (MASLD) and type 2 diabetes (T2D). Once viewed as separate conditions, experts now recognise that these two metabolic disorders are deeply interconnected, often worsening one another and increasing the risk of serious complications if left unmanaged.

MASLD, formerly known as non-alcoholic fatty liver disease (NAFLD), occurs when excess fat accumulates in the liver in people who consume little or no alcohol. It is closely linked to obesity, insulin resistance, high blood pressure, and abnormal cholesterol levels. T2D, characterised by elevated blood sugar due to insulin resistance or impaired insulin production, shares many of the same underlying risk factors. When these two conditions overlap, the consequences can be severe.

Studies show that a significant proportion of people with T2D also have MASLD, though many remain undiagnosed. Because MASLD often produces no obvious symptoms in its early stages, patients may only discover the condition after routine blood tests reveal elevated liver enzymes or imaging scans show fat deposits. By that stage, some individuals may already have progressed to more advanced liver damage, including inflammation, fibrosis, or even cirrhosis.

The overlap between MASLD and T2D creates a dangerous cycle. Insulin resistance, a hallmark of T2D, promotes fat accumulation in the liver. In turn, liver fat and inflammation can worsen insulin resistance, making blood sugar more difficult to control. This metabolic interplay increases the risk of cardiovascular disease, kidney damage, and liver-related complications.

Despite the clear connection, healthcare systems often treat MASLD and T2D separately. Patients may see endocrinologists for diabetes management and gastroenterologists or hepatologists for liver issues, with limited coordination between specialties. Experts are now calling for a more integrated model of care that addresses both conditions simultaneously through multidisciplinary teams.

Early screening is a critical first step. For individuals diagnosed with T2D, routine assessment for liver disease—using blood tests, non-invasive fibrosis scoring tools, or imaging—can help identify MASLD before significant damage occurs. Similarly, patients diagnosed with MASLD should be evaluated for diabetes or prediabetes, given the high rate of overlap.

Lifestyle intervention remains the cornerstone of treatment for both conditions. Weight reduction through balanced nutrition, regular physical activity, and behavioural support has been shown to improve insulin sensitivity and reduce liver fat. Even a modest weight loss of 5–10% can significantly improve liver health and glycaemic control. In some cases, medications used to treat T2D, such as certain glucose-lowering agents, may also offer benefits for liver inflammation and fibrosis.

Public health awareness is equally important. With rising rates of obesity and sedentary lifestyles worldwide, the prevalence of both MASLD and T2D continues to climb. Educating patients about the link between liver health and metabolic disease can encourage earlier medical consultations and proactive management.

Ultimately, addressing the MASLD–T2D overlap requires a shift in perspective. Rather than treating liver disease and diabetes as isolated conditions, clinicians must recognise them as interconnected components of a broader metabolic disorder. Through earlier detection, coordinated care, and patient-centred lifestyle support, the long-term burden of complications can be reduced, improving both quality of life and overall survival for millions of people.