Metabolic Dysfunction-Associated Steatotic Liver Disease in Type 2 Diabetes: A Narrative Review of Who Needs Fibrosis Staging and When
DOI:
https://doi.org/10.5281/zenodo.22258263Keywords:
Steatotic liver disease, Type 2 diabetes, Liver fibrosis, FIB-4, Transient elastographyAbstract
Steatotic liver disease is present in a majority of people with type 2 diabetes, and guidance now recommends that they be screened
for the fibrosis that determines whether it matters. The recommended first step is FIB-4, a score calculated from age,
transaminases and platelet count, with a value below 1.30 taken to exclude advanced fibrosis and anything above it triggering
elastography or a serum marker. The difficulty is that FIB-4 performs modestly in this population. In 149 patients with type 2
diabetes and steatotic liver disease, elastography identified advanced fibrosis in 7.4 per cent and some degree of fibrosis in 75.8
per cent, while four non-invasive scores applied to the same people flagged 14.1, 8.7, 5.4 and 3.4 per cent as high risk. Reported
areas under the curve for FIB-4 in diabetes cohorts are 0.711 and 0.735, against 0.936 for an elastography-based index. In
primary care, screening 308 patients found 59 per cent with steatotic liver disease, 7 per cent with suspected advanced fibrosis
and 1.9 per cent with cirrhosis. This review sets out what the pathway detects and where it is weakest.
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