Our Common Goal to Prevent Cirrhosis in People With Type 2 Diabetes

We appreciate the interest of Kumar et al. ( 1 ) in the recently published American Diabetes Association (ADA) consensus report ( 2 ) and support the development of national guidelines ( 3 ) that address population-specific screening, monitoring, and treatment strategies for the optimal management of metabolic dysfunction–associated steatotic liver disease (MASLD) in type 2 diabetes. As stated in the ADA consensus report, it is agreed that people with type 2 diabetes, whether associated or not with obesity ( 4 ), are at the greatest risk of developing MASLD with clinically significant fibrosis (with fibrosis stage ≥F2) and eventually cirrhosis. Resource utilization for screening and early intervention should be guided by the local epidemiology of MASLD, which can be highly variable based on geographical and socioeconomic factors. The ADA consensus report follows the person-centered collaborative care approach of the ADA “Standards of Care in Diabetes” (Standards of Care) for the evaluation and assessment of comorbidities in people with diabetes ( 5 ). In brief, it emphasizes that for diabetes education and lifestyle interventions to be successful they must be person-centered, culturally aligned, and tailored to individual needs and barriers. Of note, the consensus report was not meant to repeat the recommendations already included in the ADA Standards of Care for the management of MASLD ( 5 ) but rather expand on the rationale for these recommendations and offer additional educational material (i.e., tables and figures) for practitioners. It is important to highlight that the yearly ADA Standards of Care are developed by the ADA Professional Practice Committee, which includes experts in diabetes and its complications who follow a rigorous evidence-based medicine and guideline development methodology (described in-depth in the introduction and methodology section of the Standards of Care [ 6 ]). Finally, we agree that availability and affordability of pharmacological therapy are critical to patients and physicians. The ADA consensus report also emphasizes the need for optimizing glucose-lowering and weight management medications in MASLD as a cost-effective approach, eventually resorting to metabolic steatohepatitis–specific therapies when needed, with treatment recommendations that focus on safety and efficacy based on best available evidence.