Early intervention crucial for adults at risk for MASLD

 

Diabetes care and education specialists should screen adults with prediabetes or type 2 diabetes for metabolic dysfunction-associated steatotic liver disease and intervene early in disease progression, speakers said at the Association of Diabetes Care and Education Specialists annual meeting.

 

Lifestyle interventions such as increased physical activity, dietary changes and improved sleep are crucial for adults at risk for MASLD, and medications such as semaglutide and resmetirom also play a role, the speakers said.

 

Key takeaways:

• Adults with type 2 diabetes or prediabetes plus cardiometabolic risk factors should be screened for MASLD.• Increased physical activity, dietary change and improved sleep may lower MASLD risk.

• Diabetes care and education specialists should identify people with diabetes at risk for metabolic dysfunction-associated steatotic liver disease and intervene early in disease progression, according to two speakers.

• Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common comorbidity for people with diabetes.

 

Susan Cornell, PharmD, CDCES, FAPhA, FADCES, professor emeritus at Midwestern University College of Pharmacy; diabetes care and education specialist and consultant at Bolingbrook Christian Health Center and Will Grundy Medical Clinic; and a Healio | Endocrine Today Editorial Board Member, said

 

approximately 70% of people with type 2 diabetes and

20% of those with type 1 diabetes have MASLD. Additionally, Cornell said,

about half of people with diabetes and MASLD will go on to develop metabolic dysfunction-associated steatohepatitis (MASH).

 

During a talk at the Association of Diabetes Care & Education Specialists annual meeting, Cornell and Kathy Warwick, RDN, LDN, CDCES, diabetes care and education specialist and owner of Professional Nutrition Consultants LLC, discussed the role diabetes care and education specialists can play in managing liver health for people with diabetes.

 

“The liver now needs to be in our repertoire of screening events,” Cornell said during a presentation. “Always remember lifestyle [intervention] is the cornerstone. Drugs are always added to lifestyle.”

 

There are several reasons screening for MASLD and MASH is so difficult, according to Warwick. She said the disease is typically asymptomatic for patients, though they may be experiencing degradations in health-related quality of life. Warwick said other barriers are a stigma surrounding perceived alcohol use, a MASLD diagnosis being downplayed by patients, or any symptoms being attributed to other cardiometabolic complications.

 

Additionally, Warwick said, there is a lack of awareness about MASLD among healthcare professionals, a lack of standard guidelines for treating the disease, and only two FDA-approved medications for the condition: resmetirom (Rezdiffra, Madrigal Pharmaceuticals) and semaglutide (Wegovy, Novo Nordisk).

 

“A lot of physicians don’t really know what to do with that diagnosis or what follows next,” Warwick said. “The thing that’s scary is that they give conflicting messages, the healthcare professionals, and then they are not even sure about the terminology. I see physicians still sending people to me and calling it nonalcoholic fatty liver disease.”

 

Screening and lifestyle intervention

Warwick reviewed recommendations for MASLD screening from the American Diabetes Association 2026 Standards of Care. She said people with prediabetes or type 2 diabetes with obesity, cardiometabolic risk factors or established cardiovascular disease should be screened with the Fibrosis-4 (FIB-4) index. Screening should also occur among anyone with type 2 diabetes and an alanine aminotransferase level of more than 30 U/L. Warwick said anyone who has a FIB-4 index of 1.3 or greater should undergo additional risk assessment, and adults at increased risk should be referred to a gastroenterologist or hepatologist for further evaluation and management.

 

Warwick said lifestyle intervention is crucial for adults at risk for MASLD just as it is for those at risk for other cardiometabolic diseases. Some recommendations include a diet with reduced caloric intake, more plant-based foods, increasing intake of fiber, prebiotics and healthy fat sources and limiting saturated fat, added sugars, alcohol, processed meats and other processed foods. Diabetes care and education specialists should also have people with diabetes increase physical activity, ensure they are getting high-quality sleep, address any mental health concerns and eliminate nicotine exposure.

 

“It’s important to note that we focus so much on weight when, in fact, if they just reduce their calorie intake and they just increase their physical activity a little bit, you see improvement in [liver fat],” Warwick said. “We don’t need to set impossible goals for those clients. We just need to see if we can get them moving a little bit and we just need to make them aware of the fact that if they just reduce their caloric intake a bit, they can see improvement.”

 

Medications for MASLD

Cornell said there are three goals of pharmacotherapy for adults with type 2 diabetes at high risk for MASLD:

• cardiorenal risk reduction;
• achieving and maintaining glycemic and weight goals; and
• mitigating risk for MASLD or MASH.

 

1. Among medications that could be prescribed in these patients are incretin-based therapies such as GLP-1 receptor agonists or GLP-1/glucose-dependent insulinotropic polypeptide (GIP) dual agonists. Semaglutide is the only incretin-based drug currently approved for MASLD, but healthcare professionals should not rule out other therapies, Cornell said.

 

2. “There are studies ongoing with other GLP-1s, and even in the Obesity Association guidelines, they’re saying that there is potential benefit with liraglutide (Saxenda/Victoza, Novo Nordisk) and tirzepatide (Mounjaro/Zepbound, Eli Lilly),” Cornell said. “One of the things we want to think about from a medication standpoint is double dipping. Can we treat more than one condition with one drug?”

 

3. Other options include pioglitazone, which can reduce hepatic steatosis and inflammation and increase insulin uptake in peripheral tissue; SGLT2 inhibitors, which can decrease hepatic fat and improve cardiometabolic parameters; and resmetirom, which can improve lipid metabolism and lower fat accumulation and liver inflammation.

 

Cornell said patients should not be treated with medications alone, and that drugs must be used in conjunction with lifestyle intervention.

“Medicine is always added to lifestyle,” Cornell said. “Because [patients] are so focused on glucose, they forget about the benefits to the heart, the kidneys and the liver. [We are] just reminding them that there’s more involved than your sugar.”

 

 

Source:

Warwick K, et al. Presentation D01. Presented at: ADCES26; Aug. 7-10, 2026; Columbus, Ohio.

Disclosures:

Cornell reports advising for Novo Nordisk and speaking for Boehringer Ingelheim. Warwick reports no relevant financial disclosures.

 

From www.healio.compress release

 

 

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