S2816 Identifying Screening Deficits for MASLD in the Diabetic Population at an Academic Endocrinology Clinic

Introduction: The incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) is rising and diabetes is a major risk factor. The American Diabetes Association has implemented screening guidelines for MASLD in diabetics with screening tools such as the Fibrosis-4 (FIB-4) score. Screening these patients for MASLD is crucial to improving outcomes. This quality improvement (QI) project aims to identify deficits in screening at our academic endocrinology clinic and examine the clinical variables that may impact the FIB-4 score. Methods: In this initial phase, we included a random sample of 200 diabetic patients from the Wayne Health Endocrinology clinic who had liver enzymes and complete blood counts (CBC) recorded in the past 12 months. A FIB-4 score was calculated to identify those at risk for F2 or greater fibrosis (advanced fibrosis), defined as a FIB-4 >1.3. We collected demographic data, diabetes-related variables including hemoglobin A1c (HbA1c), insulin and glucose-like peptide 1 (GLP-1) agonist use, and available liver imaging. An educational session was provided to the endocrinology department focusing on MASLD screening, FIB-4 calculation, and appropriate referrals for Fibroscans. Results: Among the 200 patients in our initial cohort, the mean FIB-4 score was 1.15. 68 (34%) patients were at risk for advanced fibrosis (mean FIB-4 of 1.9). BMI >30 was associated with higher FIB4 (mean 1.28 v. 1.06; P = 0.017), as was type 2 diabetes (mean 0.75 in type 1 v. 1.2 in type 2; P = 0.004). GLP-1 agonist use was associated with lower FIB-4 (P = 0.012), with 11.1% of patients on GLP-1 agonists at risk for advanced fibrosis compared to 31.4% of patients not on them (P = 0.03). Only 2 (2.9%) patients at risk for advanced fibrosis had Fibroscans. Conclusion: Our findings highlight a significant gap in MASLD screening within our diabetic population, with only 3% at risk for advanced fibrosis on FIB-4 testing undergoing Fibroscan testing. Contributing factors include a lack of provider awareness regarding this testing and a lack of institutional screening algorithms. GLP-1 agonist use was associated with a lower FIB-4, likely due to its weight loss effects. Type 2 diabetics likely had higher FIB-4 scores than type 1 diabetics due to their link to metabolic dysfunction. Future QI steps include tracking FIB-4 calculation rates, appropriate Fibroscan orders, and gastroenterology referrals for advanced fibrosis.