Factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus and metabolic dysfunction-associated steatotic liver disease: a single-center retrospective study

Background/aims To identify factors associated with significant liver fibrosis in patients with type 2 diabetes mellitus (T2DM) and metabolic dysfunction-associated steatotic liver disease (MASLD) and to inform clinical risk stratification. Methods We retrospectively included adults hospitalized in the Department of Endocrinology, Nanjing Drum Tower Hospital, from January 2018 to December 2025 who had T2DM, MASLD, and vibration-controlled transient elastography (VCTE). Significant fibrosis was defined as liver stiffness measurement ≥ 8 kPa. Missing data were handled by multiple imputation (five datasets). After multicollinearity assessment, variables were entered into a multivariable logistic regression model, with a sensitivity analysis substituting ALT for AST. Results Among 1355 patients, 584 (43.10%) had significant fibrosis. Age (OR = 1.036), CAP grade (S1: OR = 1.808; S2: OR = 2.597; S3: OR = 2.709), AST (OR = 1.025), GGT (OR = 1.006), and hyperuricemia (OR = 1.345) were positively associated with significant fibrosis. BMI was not independently associated (OR = 1.034, 95% CI 0.993–1.077). SGLT-2 inhibitor use was inversely associated (OR = 0.618), whereas glinide use was positively associated (OR = 2.524); these medication findings were exploratory because treatment timing relative to VCTE was unavailable. Diabetic macrovascular disease showed an inverse association (OR = 0.582) that should not be interpreted as protective. ALT remained positively associated in sensitivity analysis (OR = 1.014). Conclusions Age, CAP grade, transaminase levels, GGT, and hyperuricemia were associated with significant fibrosis in patients with T2DM and MASLD. Medication-related associations require prospective confirmation.