Most people who receive a diabetes diagnosis quickly learn the importance of controlling their blood sugar levels to keep their eyes, kidneys, heart, and peripheral nerves healthy. But they don’t know much about what could happen to their liver.

A panel of experts from the American Diabetes Association (ADA) recommends incorporating liver health into initial conversations between health providers and patients at risk for or diagnosed with diabetes.

The ADA recently published a consensus report that urges physicians to screen patients with type 2 diabetes or prediabetes to see if they are at risk for or have developed a liver disease caused by fat accumulation in this organ.

This condition, metabolic dysfunction‑associated steatotic liver disease (MASLD), often does not cause symptoms initially but can progress to cirrhosis, liver failure, and liver cancer without early diagnosis and intervention.

Previously known as non‑alcoholic fatty liver disease (NAFLD), this condition can affect people with or without diabetes. But it is increasingly common—though often unrecognized—among people with diabetes, particularly type 2, and especially when obesity is also present.

Liver health has not been one of the main complications traditionally monitored for disease prevention, unlike retinopathy, nephropathy, and diabetic neuropathy.

However, hepatic steatosis affects approximately two in every three people with type 2 diabetes and puts them at a higher risk of:

MASLD is also associated with:

New studies emphasize that most people and their health providers are unaware of the serious hepatic or extrahepatic health risks associated with MASLD and the need for early identification.

In recognition of this knowledge gap and the growing prevalence of MASLD, this consensus report is a call to action to screen for liver conditions and stratify the risk of people with prediabetes and type 2 diabetes, particularly if obesity is also present.

The authors say that health professionals must recognize that early diagnosis is possible through noninvasive tests that stratify individuals based on their risk of developing cirrhosis.

Early diagnosis can encourage the adoption of healthier lifestyle habits or the initiation of pharmacological treatments for obesity and type 2 diabetes, which can prevent disease progression and, ultimately, cirrhosis.

Many medications to treat this liver condition are currently in development. In 2024, the US Food and Drug Administration (FDA) approved resmetirom as the first pharmacological treatment for people with this disease.

This guidance also describes the best practices for monitoring MASLD once it is diagnosed or is responding to treatment.

Since managing hepatic and extrahepatic conditions associated with diabetes and MASLD is complex, this guidance recommends training multidisciplinary teams to support primary care physicians and endocrinologists, including nutritionists, diabetes care and education specialists, behavioral health experts, obesity management teams, pharmacists, hepatologists, and other specialists.

Currently, numerous healthcare barriers stand in the way of optimal, person‑centered MASLD care in primary care settings. This guidance also discusses integrating management strategies in electronic medical records (EMRs) to improve care and the impact of alcohol use on liver health and offers considerations for managing diabetes in people with cirrhosis.

MASLD‑related cirrhosis can be prevented in people with diabetes through early diagnosis, proper treatment, and long‑term monitoring, similar to the management of diabetes‑related microvascular complications (retinopathy, nephropathy, or neuropathy) or cardiovascular diseases.

With improved clinician awareness and action, individualized education, more efficient care models, and robust public health policies, the aim is to prompt a change in clinical practice that leads to improved outcomes and quality of life in people with diabetes and MASLD.