Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent among patients with type 2 diabetes mellitus (T2DM), a population at increased risk for advanced liver fibrosis. Current guidelines recommend the Fibrosis-4 (FIB-4) index as a first-line fibrosis risk stratification tool; however, its implementation in routine clinical practice remains uncertain. Aim To evaluate the real-world feasibility of FIB-4-based fibrosis risk stratification in patients with T2DM and MASLD. Methods We conducted a retrospective cross-sectional study including adult outpatients with T2DM and MASLD evaluated at a national referral center in Santo Domingo, Dominican Republic, between March 2022 and January 2025. Feasibility was defined as the proportion of patients with sufficient laboratory data to calculate FIB-4. Results A total of 397 patients were included. Only 143 patients (36.0%) had complete laboratory data required for FIB-4 calculation, while 254 (64.0%) lacked at least one required variable. AST and ALT were the most frequently missing laboratory parameters. Among patients with calculable FIB-4 values, 16 (11.2%) were classified as high risk for advanced fibrosis according to age-adjusted thresholds. Conclusions In this real-world cohort of patients with T2DM and MASLD, guideline-recommended FIB-4-based fibrosis risk stratification showed limited feasibility due to incomplete routine laboratory data. These findings highlight opportunities to improve the integration of standardized fibrosis risk assessment into routine diabetes care.
Contreras et al. (Sun,) studied this question.
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