Is there a connection between Type 2 Diabetes and MASH?

There is a connection between MASH and Type 2 Diabetes¹, and both conditions should be managed with the assistance of your healthcare provider

2 min read |

Nadia Sadi, Denmark, living with MASH

Understanding the link between Type 2 Diabetes and MASH

Your liver is a vital organ and is involved in many things. One of these is the regulation of the body's blood sugar. The build-up of excess fat in the liver is at the core of MASLD and MASH can increase your blood sugar levels². In turn, increased blood sugar levels can cause liver damage¹.

1 in 3 people living with Type 2 Diabetes are also living with MASH³ (formerly known as NASH). 
Living with MASH increases your chances of developing Type 2 diabetes⁴. More liver scarring means a higher diabetes risk².

MASH comorbidities

MASH is closely linked with Type 2 Diabetes but can also be associated with:

Overweight and obesity - More than one in three people living with obesity are also living with MASH³.
Dyslipidemia - People living with MASH are more likely to have abnormal lipid levels⁵.  
Hypothyroidism - Hypothyroidism can cause high levels of bad cholesterol, which can lead to fat accumulation in the liver⁶. 
Hypertension - Hypertension, typically associated with cirrhosis, can also develop in earlier stages of MASH⁷.

MASH and Type 2 Diabetes: From diagnosis to management

Type 2 Diabetes can be diagnosed with a blood test. If you are living with diabetes, your healthcare provider may recommend an examination of your liver to assess fat build-up and liver function.

Testing for MASH often begins with a FIB-4 score, calculated from routine blood tests. This helps assess the likelihood of fibrosis (scarring) in the liver. Further evaluation may include imaging (e.g., ultrasound or MRI) and additional blood tests to assess liver health and confirm a diagnosis of MASH.

In case the imaging and blood tests are inconsistent, a liver biopsy may be required to diagnose the severity of MASH. 

For both conditions, lifestyle modifications such as dietary changes and staying active are key to a healthy lifestyle⁸. Along with lifestyle modifications, other interventions may be necessary to help control blood sugar levels and other metabolic risk factors for people living with Type 2 Diabetes.

For MASH, emerging therapies are now available that can help address liver damage and fibrosis⁸. Your healthcare provider can determine the most appropriate course of treatment, which may involve a combination of lifestyle changes and medication.

MASH and MASLD are updated terms for conditions previously known as NASH (non-alcoholic steatohepatitis) and NAFLD (non-alcoholic fatty liver disease). Similarly, "steatotic liver disease" is the current term for what was once called "fatty liver disease".

Mala Dharmalingam, Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6063173/  Last accessed: August 2024
Amalia Gastaldelli, From NASH to diabetes and from diabetes to NASH: Mechanisms and treatment options:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001557/ Last accessed: September 2024
Quek J, Chan KE, Wong ZY, et al., Global prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in the overweight and obese population: a systematic review and meta-analysis: https://pubmed.ncbi.nlm.nih.gov/36400097/ Last accessed: August 2024
Khaled K Aldossari, The epidemiology and characteristics of patients with diabetes with or without NASH: a systematic review: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10782311/  Last accessed: September 2024
P. Barton, Nonalcoholic Fatty Liver Disease and Cardiovascular Risk: A Scientific Statement From the American Heart Association: https://www.ahajournals.org/doi/10.1161/ATV.0000000000000153#R56%20R57%20R58  Last accessed: August 2024
Daniela Maria Tanase, Hypothyroidism-Induced Nonalcoholic Fatty Liver Disease (HIN): Mechanisms and Emerging Therapeutic Options: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460638/  Last accessed: August 2024
Marvin Ryou, Nonalcoholic fatty liver disease and portal hypertension: https://www.explorationpub.com/Journals/em/Article/100111 Last accessed: October 2024
Georgia Anastasioua, Expanding diagnostic and therapeutic horizons for MASH: Comparison of the latest and conventional therapeutic approaches: https://www.metabolismjournal.com/article/S0026-0495(24)00272-5/fulltext Last accessed: October 2024

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