Type 2 diabetes increases the risk of progression to metabolic dysfunction-associated steatohepatitis-related cirrhosis in a real world setting.

Challenge

Despite T2D being prevalent in MASLD and associated with worse outcomes, the size of the independent contribution of T2D to the risk of developing MASH-related cirrhosis—separate from baseline fibrosis severity—had not been quantified in a prospective real-world cohort with longitudinal follow-up.

Solution

The TARGET-NASH endocrinology-hepatology collaboration used data from MASLD patients managed at both hepatology and endocrinology practices to model cirrhosis progression risk by T2D status, controlling for FIB-4 risk category, with results consistent across low and high baseline fibrosis subgroups.

Impact

Demonstrating a consistent, approximately twofold increase in cirrhosis progression risk associated with T2D across fibrosis subgroups provides a strong real-world foundation for T2D-based enrichment in MASH trials and reinforces the clinical case for early intervention in MASLD patients with diabetes.