Practice Guideline

. 2024 Oct 30;8(11):e0571.

doi: 10.1097/HC9.0000000000000571. eCollection 2024 Nov 1.

Clinical care guidance in patients with diabetes and metabolic dysfunction-associated steatotic liver disease: A joint consensus

Jee-Fu Huang^{1

2

3}, Tien-Jyun Chang⁴, Ming-Lun Yeh¹, Feng-Chih Shen^{5

6}, Chi-Ming Tai⁷, Jung-Fu Chen⁵, Yi-Hsiang Huang^{8

9}, Chih-Yao Hsu¹⁰, Pin-Nan Cheng^{11

12}, Ching-Ling Lin¹³, Chao-Hung Hung^{6

14}, Ching-Chu Chen^{15

16}, Mei-Hsuan Lee⁸, Chun-Chuan Lee^{17

18}, Chih-Wen Lin⁷, Sung-Chen Liu^{17

18}, Hwai-I Yang¹⁹, Rong-Nan Chien²⁰, Chin-Sung Kuo^{21

22}, Cheng-Yuan Peng^{23

24}, Ming-Ling Chang²⁰, Chung-Feng Huang¹, Yi-Sun Yang²⁵, Hung-Chih Yang^{4

26}, Han-Chieh Lin²⁷, Horng-Yih Ou^{11

12}, Chun-Jen Liu²⁸, Chin-Hsiao Tseng⁴, Jia-Horng Kao⁴, Wan-Long Chuang¹, Chien-Ning Huang²⁵, Pei-Jer Chen⁴, Chih-Yuan Wang⁴, Ming-Lung Yu^{1

3

29}

Affiliations

¹ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁶ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁸ Institute of Clinical Medicine, National Yang Ming Chiao Tung University Faculty of Medicine, Taipei, Taiwan.
⁹ Healthcare and Services Center and Therapeutic and Research Center of Liver Cancer, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan.
¹¹ Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
¹² College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹³ Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
¹⁴ Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹⁵ Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
¹⁶ School of Chinese Medicine, China Medical University, Taichung, Taiwan.
¹⁷ Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
¹⁸ Department of Medicine, Mackay Medical College, Taipei, Taiwan.
¹⁹ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
²⁰ Department of Gastroenterology and Hepatobiliary Disease, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.
²¹ Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
²² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²³ Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan.
²⁴ School of Medicine, China Medical University, Taichung, Taiwan.
²⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
²⁶ Department and Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan.
²⁷ Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.
²⁸ Division of Gastroenterology & Hepatology, Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
²⁹ School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.

PMID: 39470335
PMCID: PMC11524742
DOI: 10.1097/HC9.0000000000000571

Practice Guideline

Clinical care guidance in patients with diabetes and metabolic dysfunction-associated steatotic liver disease: A joint consensus

Jee-Fu Huang et al. Hepatol Commun. 2024.

. 2024 Oct 30;8(11):e0571.

doi: 10.1097/HC9.0000000000000571. eCollection 2024 Nov 1.

Authors

Affiliations

¹ Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
² Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
³ College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
⁴ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁶ School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁸ Institute of Clinical Medicine, National Yang Ming Chiao Tung University Faculty of Medicine, Taipei, Taiwan.
⁹ Healthcare and Services Center and Therapeutic and Research Center of Liver Cancer, Taipei Veterans General Hospital, Taipei, Taiwan.
¹⁰ Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei City Hospital Renai Branch, Taipei, Taiwan.
¹¹ Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
¹² College of Medicine, National Cheng Kung University, Tainan, Taiwan.
¹³ Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan.
¹⁴ Division of Hepatogastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
¹⁵ Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.
¹⁶ School of Chinese Medicine, China Medical University, Taichung, Taiwan.
¹⁷ Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
¹⁸ Department of Medicine, Mackay Medical College, Taipei, Taiwan.
¹⁹ Genomics Research Center, Academia Sinica, Taipei, Taiwan.
²⁰ Department of Gastroenterology and Hepatobiliary Disease, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan.
²¹ Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
²² School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
²³ Department of Internal Medicine, Center for Digestive Medicine, China Medical University Hospital, Taichung, Taiwan.
²⁴ School of Medicine, China Medical University, Taichung, Taiwan.
²⁵ Division of Endocrinology and Metabolism, Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan.
²⁶ Department and Graduate Institute of Microbiology, National Taiwan University College of Medicine, Taipei, Taiwan.
²⁷ Division of Gastroenterology and Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.
²⁸ Division of Gastroenterology & Hepatology, Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan.
²⁹ School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine, Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung, Taiwan.

PMID: 39470335
PMCID: PMC11524742
DOI: 10.1097/HC9.0000000000000571

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide, affecting >30% of the global population. Metabolic dysregulation, particularly insulin resistance and its subsequent manifestation as type 2 diabetes mellitus, serves as the fundamental pathogenesis of metabolic liver disease. Clinical evidence of the recent nomenclature evolution is accumulating. The interaction and impacts are bidirectional between MASLD and diabetes in terms of disease course, risk, and prognosis. Therefore, there is an urgent need to highlight the multifaceted links between MASLD and diabetes for both hepatologists and diabetologists. The surveillance strategy, risk stratification of management, and current therapeutic achievements of metabolic liver disease remain the major pillars in a clinical care setting. Therefore, the Taiwan Association for the Study of the Liver (TASL), Taiwanese Association of Diabetes Educators, and Diabetes Association of the Republic of China (Taiwan) collaboratively completed the first guidance in patients with diabetes and MASLD, which provides practical recommendations for patient care.

PubMed Disclaimer

Conflict of interest statement

Jee-Fu Huang: consultant of Roche, Gilead, Sysmex, and Aligos. Speaker for Abbvie, BMS, Gilead, Merck, Sysmex, and Roche. Chung-Feng Huang: speaker for Abbvie, BMS, Bayer, Gilead, Merck, and Roche. Chin-Sung Kuo: investigators of clinical trials sponsored by Novo Nordisk and AstraZeneca. Wan-Long Chuang: consultant of Gilead, AbbVie, BMS, PharmaEssentia, and Aligos; Speaker for Gilead, AbbVie, BMS, and PharmaEssentia. Ming-Lung Yu: Research grant from Abbott, BMS, Merck, and Gilead; Consultant of Abbvie, Abbott, Ascletis, BMS, Merck, Gilead, and Roche; Speaker for Abbvie, Abbott, BMS, Merck, Gilead, and IPSEN. The remaining authors have no conflicts to report.

Figures

**FIGURE 1**
The screening and fibrosis assessment algorithm in metabolic dysfunction–associated steatotic liver disease. Abbreviations: DM, diabetes; FIB-4, fibrosis-4; LSM, Liver stiffness measurement.

**FIGURE 2**
Risk stratification for the patients with metabolic dysfunction–associated steatotic liver disease. Abbreviations: BMI, body mass index; CVD, cardiovascular disease.

**FIGURE 3**
When to refer to a hepatologist/diabetologist in diabetes with metabolic dysfunction–associated steatotic liver disease. Abbreviations: FIB-4, fibrosis-4; HbA1c, hemoglobin A1c; VCTE, vibration-controlled transient elastography.

**FIGURE 4**
The spectrum and related outcomes of metabolic dysfunction–associated steatotic liver disease.

**FIGURE 5**
The comprehensive directions of patient care in MASLD. Abbreviations: CHF, congestive heart failure; CVD, cardiovascular disease; MASLD, metabolic dysfunction–associated steatotic liver disease.

See this image and copyright information in PMC

References

1. Alqahtani SA, Chan WK, Yu ML. Hepatic outcomes of nonalcoholic fatty liver disease including cirrhosis and hepatocellular carcinoma. Clin Liver Dis. 2023;27:211–23. - PubMed
1. Eslam M, Newsome PN, Sarin SK, Anstee QM, Targher G, Romero-Gomez M, et al. . A new definition for metabolic dysfunction-associated fatty liver disease: An international expert consensus statement. J Hepatol. 2020;73:202–9. - PubMed
1. Rinella ME, Lazarus JV, Ratziu V, Francque SM, Sanyal AJ, Kanwal F, et al. . A multisociety Delphi consensus statement on new fatty liver disease nomenclature. Hepatology. 2023;79:1966–86. - PMC - PubMed
1. Stefan N, Cusi K. A global view of the interplay between non-alcoholic fatty liver disease and diabetes. Lancet Diabetes Endocrinol. 2022;10:284–96. - PubMed
1. Ajmera V, Cepin S, Tesfai K, Hofflich H, Cadman K, Lopez S, et al. . A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes. J Hepatol. 2023;78:471–8. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Clinical care guidance in patients with diabetes and metabolic dysfunction-associated steatotic liver disease: A joint consensus

Affiliations

Clinical care guidance in patients with diabetes and metabolic dysfunction-associated steatotic liver disease: A joint consensus

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical