Impact of Diabetes and its management on MASLD risk

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease, affecting up to 30% of the adult population. Diabetes Mellitus (DM) is an important risk factor for MASLD. However, it is rarely differentiated whether DM is known and well controlled. The primary objective of our study is to evaluate the impact of DM and its management on the risk of MASLD development.

Methods: This study included 419,325 participants from the UK Biobank database. We conducted a univariate Cox regression analysis across six groups based on presence and management of DM by including ICD codes, medication history as well as current glucose and HBA1c levels, focusing on the risk of developing MASLD (diagnosed by ICD-10 codes).

Results: Compared to the Definitely-No-DM group, the risk of MASLD significantly increased in all five other diabetic groups. Among these, the Well-Managed-DM group (DM patients whose HbA1c<53 mmol/mol after taking antidiabetic medication) had still a 380% increase in MASLD risk, while the Poorly-Managed-DM group had an even higher increase of 433% (HR=4.80, HR=5.33, p<0.001). Patients in the Undiagnosed-DM had a 64.9% elevated MASLD risk compared to controls.

Conclusion: The study findings indicate that effective blood glucose management is associated with a reduced risk of MASLD. When looking at DM in MASLD patients, DM should be recognized, and DM management should be started especially in patients at risk of MASLD.

Publication History

Article published online:
20 January 2025