Metabolic dysfunction–associated steatotic liver disease (MASLD) remains underrecognized in diabetes care due to the lack of structured detection pathways in primary healthcare. To evaluate the feasibility and performance of a stepwise diagnostic pathway for identifying the full spectrum of MASLD in adults with type 2 diabetes in primary healthcare settings. A diagnostic pathway for early detection across the MASLD spectrum, including steatosis, metabolic-dysfunction associated steatohepatitis (MASH), liver fibrosis risk, and significant fibrosis, was integrated into a multicomponent diabetes care program within the public health system. A secondary exploratory analysis used multivariable logistic regression to identify factors independently associated with MASLD. Among 454 adults with type 2 diabetes, MASLD was identified in 51.5%, and MASH in 22.2%. Through stepwise assessment, 22.7% showed intermediate-to-high fibrosis risk, and among those who underwent transient elastography, significant fibrosis was confirmed in 27.9% of individuals with increased risk, yielding an estimated prevalence of 10.6% in the MASLD group and 5.9% overall. In multivariable analysis, female sex, elevated liver enzymes, and higher body mass index were independently associated with MASLD, with a non-linear association across BMI categories. Implementing structured care pathways for the identification and management of MASLD is feasible and essential to mitigate the burden of diabetes and liver disease. Strengthening primary care capacity remains crucial for systematic integration of MASLD identification in routine care. • A MASLD diagnostic pathway was implemented in primary diabetes care. • MASLD was identified in 51.5% of adults with type 2 diabetes. • One in five patients met criteria for MASH or had fibrosis risk. • FIB-4 identified 22.7% with intermediate-to-high fibrosis risk. • Female sex, higher BMI, and elevated ALT/AST were independently associated with MASLD.
Silva-Tinoco et al. (Wed,) studied this question.