The Hidden Burden of Diabetes: Why Metabolic Liver Health Can No Longer Be Overlooked

Strengthening MASLD Screening Is a Critical Step in Preventing Disease Progression

According to the International Diabetes Federation (IDF) global survey released in 2025, the burden faced by people living with diabetes extends far beyond glycemic control.

The survey revealed that two out of five individuals with diabetes have experienced negative treatment in the workplace, and one in four feels uncomfortable administering insulin or monitoring blood glucose at work.

These findings highlight an often-overlooked reality:
daily diabetes management itself represents a substantial psychological and lifestyle burden.

In modern work environments, people with diabetes must remain vigilant about blood glucose fluctuations, adhere to medication schedules, adjust dietary intake, and attend regular medical follow-ups—often while navigating workplace cultures that lack understanding, accommodation, or support for chronic disease management.

Amid these pressures, another major yet largely silent health threat is frequently overlooked:
metabolic dysfunction–associated steatotic liver disease (MASLD).

Why Should People With Diabetes Be Screened for MASLD?

Robust clinical evidence has demonstrated that the coexistence of diabetes and MASLD represents one of the most hazardous combinations in metabolic disease.

• Up to 70% of individuals with diabetes are estimated to have MASLD

• Diabetes accelerates liver fibrosis progression and increases the risk of hepatocellular carcinoma when MASLD is present

• MASLD is a major but underrecognized contributor to increased mortality in people with diabetes

• MASLD is typically asymptomatic in its early stages, and without proactive screening, opportunities for timely intervention are often missed

IDF data suggest that many individuals with diabetes already experience anxiety and distress related to daily glycemic management. It is therefore unsurprising that clinically silent liver disease often goes unnoticed.

However, once liver fibrosis or cirrhosis develops, hepatic injury may become irreversible.

For people living with diabetes, early identification of MASLD is not merely liver function monitoring—it represents a critical safeguard against preventable disease progression.

Recommended MASLD-Related Assessments for People With Diabetes

Based on international consensus statements and contemporary clinical guidelines, individuals with diabetes are advised to undergo:

• Non-invasive liver assessment every 1–2 years

• Transient elastography (FibroScan®) for liver stiffness evaluation

• FIB-4 index for fibrosis risk stratification

• Referral to hepatology specialists when advanced fibrosis is suspected (e.g., FIB-4 > 2.67)

These approaches allow early risk identification without exposing patients to invasive procedures.

World Diabetes Day: Focusing on Overall Risk Reduction

The IDF survey underscores that people with diabetes already shoulder substantial psychological, physical, and occupational stress.

This is precisely why, within the context of chronic disease management, proactively addressing MASLD risk is a crucial step toward preventing disease progression and reducing premature mortality.

Routine MASLD screening enables intervention before symptoms arise, helping preserve liver health and improve long-term outcomes.

Center for Metabolic Disorders and Obesity, KMU

Advancing Metabolic Health Through Early Detection

The Center for Metabolic Disorders and Obesity (CMDO), Kaohsiung Medical University, is committed to:

• Providing scientific, non-invasive assessments for metabolic liver disease

• Advancing research on risk factors, early warning signals, and timely intervention strategies for metabolic disorders

On World Diabetes Day, we share a simple but essential message:

Diabetes care extends beyond glycemic control.
Liver health must also be recognized and addressed.
MASLD screening should begin now.