Current management of MASLD in type 2 diabetes.

Steatotic liver disease encompasses a wide range of disease states, from steatosis to steatohepatitis and ultimately cirrhosis. As these stages progress, several severe hepatic and non-hepatic issues are triggered. Patients with diabetes exhibit accelerated progression through the MASLD spectrum, with increased liver-related mortality. To recognize the close association between MASLD and type 2 diabetes (T2D), it must be understood that lipid and glucose metabolism are closely intertwined. Insulin resistance and obesity are central features of both MASLD and T2D and stem from multifactorial etiologies related to lifestyle, environmental, genetic, and epigenetic factors. Due to the shared physiopathological routes and the higher risk of disease progression attributed to MASLD and T2D, hepatic steatosis should be suspected and screened for in patients with T2D. Once the diagnosis of MASLD is established, lifestyle interventions, with close follow-up and strict metabolic control must be implemented. The presence of clinically significant fibrosis warrants management by an interdisciplinary team, including a gastroenterologist or hepatologist. Current pharmacotherapies that target metabolic dysfunction aim to prevent cardiovascular disease and MASH cirrhosis. This review discusses drugs approved for T2D treatment with liver-related benefits, as well as ongoing research for dual treatment strategies.