Screening for Metabolic Dysfunction–Associated Steatotic Liver Disease in Patients With Type 2 Diabetes: Are We Doing Enough?

OBJECTIVE Patients with type 2 diabetes are at an elevated risk for metabolic dysfunction–associated steatotic liver disease and advanced liver fibrosis. Multiple professional societies recommend initiating screening with a fibrosis-4 (FIB-4) index score calculation. This study aimed to evaluate the frequency of laboratory assessments necessary for FIB-4 score calculation in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A retrospective analysis of de-identified electronic medical records from 337,094 patients aged 40–75 years with type 2 diabetes was conducted to evaluate the completion rate of FIB-4 scoring and adherence to other recommended measurements and medications, including urinary albumin measurement and statin use. RESULTS Only 33% of patients with type 2 diabetes had all necessary components for FIB-4 score calculation, although this rate increased significantly over time (odds ratio 2.51, 95% CI 2.44–2.58) in the period from 2020 to April 2024 compared with 2010–2014. Urinary albumin measurements also increased but remained low at 13% during the period from 2020 to April 2024. Prescriptions for statin and newer antihyperglycemic medications significantly increased. CONCLUSION Our findings indicate that, although testing frequency for liver health in patients with type 2 diabetes is gradually increasing, substantial gaps in clinical practice persist.