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Review
. 2025 Aug;29(3):407-429.
doi: 10.1016/j.cld.2025.04.003. Epub 2025 May 27.

The Liver in Diabetes and Metabolic Syndrome

Mia C Mahmoud  1 , Manal F Abdelmalek  2
Affiliations
Review

The Liver in Diabetes and Metabolic Syndrome

Mia C Mahmoud et al. Clin Liver Dis. 2025 Aug.

Abstract

A bidirectonal relationship between insulin resistance, diabetes and metabolic dysfunction-associated steatotic liver disease exists. In those with metabolic syndrome, impairments of glucose and lipid metabolism lead to increased liver fat, necroinflammation (steatohepatitis) and subsequent hepatic fibrosis. An integrated perspective and heightened awareness of metabolic dysfunction associated steatotic liver disease is critical to tempering the rising epidemic metabolic dysfunction associated steatohepatiitis, cirrhosis, liver cancer and need for liver transplanation patients with diabetes and metabolic syndrome. Medical and surgical treatments targeting insulin resistance, obesity and diabetes mellitus hold promise in improving lipotoxic liver injury which contributes to steatohepatitis and progressive hepatic fibrosis.

Keywords: Hyperglycemia; Insulin resistance; MASH; MASLD; Metabolic syndrome; Type 2 diabetes.

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Conflict of interest statement

Disclosure M.C. Mahmoud: Nothing to disclose. M.F. Abdelmalek: Grants/Research:89bio, United States, Akero, Gilead Sciences, United States, Hanmi Pharmaceuticals, Inventiva, France, Madrigal Pharmaceuticals, United States, Novo Nordisk, Denmark. Consulting/Advisory Boards: 89Bio, Boehringer-Ingelheim, Hanmi Pharmaceuticals, Intercept, Inventiva, Madrigal Pharmaceuticals, Novo Nordisk. Speaker Honorarium: MASH Alliance, Fishawack, Inc, Medscape, Chronic Liver Disease Foundation. Royalties: Up to Date.