MASLD treatment strategies in people with diabetes

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) affects over 80% of patients with type 2 diabetes (T2D) in Argentina, demanding a comprehensive clinical approach to prevent progression to cirrhosis. The cornerstone of treatment remains intensive lifestyle modification; achieving a weight loss of 5% to 10% effectively reduces steatosis, while a reduction greater than 10% achieves fibrosis regression and steatohepatitis (MASH) resolution.

Specific hepatic pharmacotherapy is indicated for patients with MASH and clinically significant fibrosis (F2). In individuals with T2D, the use of GLP-1 receptor agonists (like semaglutide) is strongly prioritized, as they have been shown to resolve steatohepatitis, improve fibrosis, and significantly reduce cardiovascular events. Meanwhile, resmetirom (a selective THR- agonist) is approved for non-cirrhotic MASH with F2-F3 fibrosis, representing the preferred option if the patient is already receiving a GLP-1 RA for underlying obesity or diabetes. Additionally, SGLT2 inhibitors remain essential adjuncts for glycemic control and cardio-renal protection in these patients.