Treatment of type 2 diabetes with MASLD: new evidence for personalised medicine

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD), is closely linked to type 2 diabetes (T2D).1 2 This strong association is due to shared pathophysiological pathways, including insulin resistance, mitochondrial dysfunction, adipose tissue dysfunction, low-grade inflammation and dysbiosis.3 The coexistence of MASLD and T2D affects the prognosis of both diseases in a bidirectional manner that is not yet fully understood.3 Given this connection, the impact of glucose-lowering therapies on MASLD has been an important area of investigation. Among these therapies, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been associated with a decrease in liver fat content, liver enzymes and histological feature of metabolic dysfunction associated steatohepatitis (MASH) beyond their well-established cardio–renal benefits. In a study published in Gut , Mao et al performed a retrospective analysis of 399 126 patients diagnosed with T2D and MASLD, using US healthcare claims data from 2007 to 2021.4 The study used propensity score matching to compare long-term outcomes in patients treated with SGLT2i (15.7%) versus those treated …