Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes: Are We Doing Enough?
Only one in three patients with type 2 diabetes had the blood tests needed to screen for a common liver condition
SH Kim, G Hui, CW Pike, ML Jackson, M Levine, P Kwo
Diabetes Spectrum: A Publication of the American Diabetes Association, 38(4): 496-501 (2025)
Plain-language summary
In our large study of over 300,000 people with type 2 diabetes, we found that doctors are still not routinely checking for a common but serious liver condition called metabolic dysfunction-associated steatotic liver disease, despite clear screening guidelines. Only one in three patients had the simple blood tests needed to calculate a liver risk score, though this rate did improve over our 14-year study period. Similarly, we found that just 13% received a recommended urine test for kidney health, even as prescriptions for statins and newer diabetes medications rose. We are concerned about these gaps in screening because people with type 2 diabetes are at high risk for developing advanced liver scarring, and catching it early with a straightforward blood test can help prevent severe complications.
Abstract
OBJECTIVE: Patients with type 2 diabetes are at an elevated risk for metabolic dysfunction-associated steatotic liver disease and advanced liver fibrosis. Multiple professional societies recommend initiating screening with a fibrosis-4 (FIB-4) index score calculation. This study aimed to evaluate the frequency of laboratory assessments necessary for FIB-4 score calculation in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A retrospective analysis of de-identified electronic medical records from 337,094 patients aged 40-75 years with type 2 diabetes was conducted to evaluate the completion rate of FIB-4 scoring and adherence to other recommended measurements and medications, including urinary albumin measurement and statin use. RESULTS: Only 33% of patients with type 2 diabetes had all necessary components for FIB-4 score calculation, although this rate increased significantly over time (odds ratio 2.51, 95% CI 2.44-2.58) in the period from 2020 to April 2024 compared with 2010-2014. Urinary albumin measurements also increased but remained low at 13% during the period from 2020 to April 2024. Prescriptions for statin and newer antihyperglycemic medications significantly increased. CONCLUSION: Our findings indicate that, although testing frequency for liver health in patients with type 2 diabetes is gradually increasing, substantial gaps in clinical practice persist.
Details
Formatted
SH Kim, G Hui, CW Pike, ML Jackson, M Levine, P Kwo. Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes: Are We Doing Enough?. Diabetes Spectrum: A Publication of the American Diabetes Association. 2025;38(4):496-501. doi:10.2337/ds25-0028BibTeX
@article{pike2025screening,
title = {Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes: Are We Doing Enough?},
author = {Kim, SH and Hui, G and Pike, CW and Jackson, ML and Levine, M and Kwo, P},
journal = {Diabetes Spectrum: A Publication of the American Diabetes Association},
year = {2025},
volume = {38},
number = {4},
pages = {496-501},
doi = {10.2337/ds25-0028},
}
RIS
TY - JOUR
AU - Kim, SH
AU - Hui, G
AU - Pike, CW
AU - Jackson, ML
AU - Levine, M
AU - Kwo, P
TI - Screening for Metabolic Dysfunction-Associated Steatotic Liver Disease in Patients With Type 2 Diabetes: Are We Doing Enough?
JO - Diabetes Spectrum: A Publication of the American Diabetes Association
PY - 2025
VL - 38
IS - 4
SP - 496
EP - 501
DO - 10.2337/ds25-0028
ER -
- Publication Type
- Journal Article
- Journal
- Diabetes Spectrum: A Publication of the American Diabetes Association
- Date Published
- September 23, 2025
- Volume
- 38
- Issue
- 4
- Pages
- 496-501
- Digital Object Identifier
- 10.2337/ds25-0028
- PubMed Identifier
- 41257242
- PubMed Central Identifier
- PMC12620734