Real-world screening for metabolic dysfunction–associated steatotic liver disease among adults with type 2 diabetes

BACKGROUND: New treatments for metabolic dysfunction-associated steatotic liver disease (MASLD) require identification of patients at risk of progressing to cirrhosis, yet population-based screening methods are not well established. METHODS: We conducted a pilot screening study at a large academic primary care practice among patients with type 2 diabetes mellitus (T2DM). We calculated FIB-4 scores on existing labs and contacted providers with recommendations for additional testing with vibration-controlled transient elastography (VCTE) and/or specialty referral. RESULTS: (proportion of patients receiving definitive diagnosis of MASLD with F2 or higher fibrosis as a result of the intervention) among the cohort with FIB-4 > 2.66 was 12/78 (15.4%). The most common reason for fall-out was the patient not wishing to receive further evaluation, with the second being provider concerns about competing risks. DISCUSSION: The impact of population-level MASLD screening is limited by implementation barriers. Future efforts should focus on direct-to-patient outreach and methods to identify patients without competing risks who are most likely to benefit from MASLD diagnosis and specific treatment.