A new report from the American Diabetes Association (ADA) urges healthcare providers to start routinely checking liver health in people with diabetes. The guidance aims to catch and treat a condition called metabolic dysfunction-associated steatotic liver disease (MASLD) early — before it leads to serious complications.

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Why the New Liver Screening Matters

According to ADA experts, liver problems are often overlooked in diabetes care, yet MASLD affects about 70 percent of people with type 2 diabetes. Moreover, 1 in 5 already have fibrosis (advanced liver scarring) that can progress to cirrhosis (severe, permanent liver scarring) or liver cancer if left untreated.

The report notes that liver health hasn’t received the same attention as other diabetes-related complications, like kidney, nerve, or eye disease. The ADA’s new guidance calls for a shift in that approach — putting liver screening alongside other well-known checks to protect long-term health.

The ADA panel emphasized that early detection could help people make changes or begin treatment to prevent permanent liver damage.

What Is MASLD?

MASLD was formerly known as nonalcoholic fatty liver disease (NAFLD). It happens when too much fat builds up in the liver and causes inflammation or scarring. Over time, that damage can interfere with how the liver filters blood and processes nutrients.

Most people with MASLD don’t notice symptoms at first. When signs and symptoms do appear, they may include:

• Fatigue (exhaustion that doesn’t improve with rest)
• Pain in the upper right side of the abdomen
• Elevated liver enzyme levels on blood tests

If MASLD progresses to its more severe form, called metabolic dysfunction-associated steatohepatitis (MASH), it can lead to cirrhosis, liver failure, or liver cancer.

How Liver Screening Works

The ADA now recommends a two-step, noninvasive screening process for people with diabetes or prediabetes:

1. Start with a calculation, called the fibrosis-4 index (FIB-4), based on the results of a few simple blood tests. It uses age, liver enzyme levels, and platelet count to estimate scarring in the liver.
2. If results show a higher risk, follow up with an imaging test or a blood test known as an enhanced liver fibrosis (ELF) test to confirm the diagnosis.

These tests can help doctors find liver scarring early, often before symptoms appear. Most people can have the first-step FIB-4 test done through their primary care provider or endocrinologist.

Why Early Detection Saves Lives

Catching MASLD early gives people time to reverse or slow the disease. They can:

• Embrace healthy lifestyle changes — Gradual weight loss, regular physical activity, and balanced eating patterns, such as the Mediterranean diet, may all help.
• Manage blood sugar and cholesterol — Some diabetes medications, including GLP-1 receptor agonists (such as semaglutide) and pioglitazone, have also been shown to improve liver health in clinical studies.
• Limit alcohol — Alcohol can add extra strain to the liver and worsen inflammation or scarring, even in small amounts.
• Avoid medications that strain the liver — Some over-the-counter pain relievers, herbal supplements, or prescription drugs can affect liver enzymes or increase liver workload.

Because MASLD can also increase the risk for heart disease and certain cancers, keeping the liver healthy benefits the whole body.

Liver disease linked to diabetes is preventable — and even reversible — when found early. If you live with diabetes, ask your healthcare provider whether it’s time to check your liver health.

Learn more about the connection between MASLD and diabetes and ways to protect your liver.

Join the Conversation

On DiabetesTeam, people share their experiences with diabetes, get advice, and find support from others who understand.

Have you or a loved one ever been screened for liver disease as part of diabetes care? Let others know in the comments below.