2980-LB: Continuous Glucose Monitoring Use Is Associated with Lower Risk of Incident MASLD-Related Outcomes in Adults with Type 2 Diabetes: A Propensity-Matched Retrospective Cohort Study

Introduction and Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in people with type 2 diabetes (T2D) and contributes to liver fibrosis and adverse metabolic outcomes. Continuous glucose monitoring (CGM) improves glycemic management. We aimed to determine whether CGM use is associated with MASLD-related outcomes in adults with T2D. Methods: We conducted a retrospective cohort study using the TriNetX network. Adults with T2D between January 1, 2017 and January 1, 2021 were included, excluding those with preexisting liver disease. CGM exposure was defined using procedure codes. Propensity score matching (PSM) balanced demographics, comorbidities, medications, prior abdominal ultrasound use, and baseline metabolic parameters. Participants were followed up to 5 years for NAFLD/NASH, liver fibrosis, and hepatocellular carcinoma (HCC), evaluated as proxies for MASLD-related outcomes. Results: We identified 22935 CGM users and 3451321 non-CGM individuals with T2D. After PSM, 22928 matched pairs were analyzed. CGM use was associated with lower risk of NAFLD/NASH (HR 0.896; 95% CI 0.830-0.967) and liver fibrosis (HR 0.793; 95% CI 0.682-0.922), with no significant association with HCC. Abdominal ultrasound use was comparable between groups. In subgroup analyses, liver fibrosis risk reduction was greatest in those with baseline HbA1c ≥10% (HR 0.547; 95% CI 0.389-0.770). In sensitivity analyses restricted to repeated CGM use within 6-12 months (PSM n=14078 pairs), the association with reduced NAFLD/NASH risk was stronger (HR 0.794; 95% CI 0.714-0.882). Conclusion: In this large propensity-matched real-world cohort of adults with T2D, CGM use was associated with lower risk of MASLD-related outcomes. The reduction in liver fibrosis risk was particularly pronounced among those with poor baseline glycemic control. Prospective studies are needed to determine whether CGM-guided management reduces MASLD risk.