EXCLI journalJun 30, 2026

Two-way link between fatty liver disease related to metabolism and type 2 diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Jul 1, 2026

Abstract

The worldwide prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among individuals with type 2 diabetes mellitus (T2DM) exceeds 60%.

A substantial proportion of MASLD cases in T2DM patients are classified as metabolic dysfunction-associated steatohepatitis (MASH), which carries an increased risk of severe liver complications.
The coexistence of MASLD and T2DM is linked to poorer glycemic control and a higher risk of cardiovascular events, chronic kidney disease, and mortality.
MASLD is associated with an increased risk of developing T2DM, with this risk escalating with the severity of liver disease, particularly liver fibrosis.
There is a bidirectional relationship between MASLD and T2DM, contributing to liver disease progression, worsening insulin resistance, and impaired glucose metabolism.
Shared underlying mechanisms between MASLD and T2DM may include insulin resistance, low-grade inflammation, lipotoxicity, adipose tissue dysfunction, and alterations in the gut-liver axis.
Current guidelines recommend screening for liver fibrosis in T2DM patients and for dysglycemia in individuals with MASLD.

Simplified

Metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) are two common, interconnected conditions that pose a major global health challenge. The worldwide prevalence of MASLD among individuals with T2DM exceeds 60 %, with a substantial proportion of cases having metabolic dysfunction-associated steatohepatitis (MASH) and an increased risk of liver-related complications, such as cirrhosis, liver failure, or hepatocellular carcinoma. The coexistence of MASLD and T2DM is also associated with poorer glycemic control and a higher risk of cardiovascular events, chronic kidney disease, and mortality. Notably, MASLD increases the risk of developing T2DM, with risk rising stepwise with liver disease severity, especially liver fibrosis. The close bidirectional relationship between MASLD and T2DM creates a vicious cycle that drives liver disease progression, worsens insulin resistance, and impairs glucose metabolism. This likely reflects shared underlying mechanisms, including insulin resistance, low-grade inflammation, lipotoxicity, adipose tissue dysfunction, and an altered gut-liver axis. Screening strategies are crucial for MASLD and T2DM, with current guidelines recommending assessment of liver fibrosis in all individuals with T2DM and regular screening for dysglycemia in those with MASLD. Pharmacological treatments, especially incretin-based therapies, sodium-glucose cotransporter 2 inhibitors, and resmetirom, show significant benefits across metabolic, hepatic, and extrahepatic outcomes. Overall, recognizing and addressing the bidirectional relationship between MASLD and T2DM is essential for better risk stratification, earlier intervention, and reduced long-term hepatic and extrahepatic complications. This narrative review summarizes current evidence on the bidirectional relationship between MASLD and T2DM, discussing epidemiological data, pathophysiological mechanisms, clinical implications, and therapeutic options. See also the graphical abstract(Fig. 1).

Funding

Competing interests

No competing interests reported.

PubMed

Two-way link between fatty liver disease related to metabolism and type 2 diabetes

Abstract

Funding

Competing interests

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the glp-1 therapies brief

Abstract

Funding

Competing interests

Related papers

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the glp-1 therapies brief