Consensus guidelines for the diagnosis and management of metabolic dysfunction-associated steatotic liver disease in adult Asian Indians with type 2 diabetes.

BACKGROUND

Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a critical health concern among Asian Indians with type 2 diabetes (T2D), characterized by particularly high prevalence and risk of progression. The need for specific guidelines addressing this dual epidemic is vital, given the adverse metabolic characteristics of Asian Indians.

METHODS

A comprehensive literature review was conducted across major databases (PubMed, Embase, Cochrane Library, and Google Scholar) up to December 2024. For topics lacking robust evidence, a modified Delphi survey was conducted among endocrinologists, diabetologists, and gastroenterologists across India. Consensus statements were developed through a systematic process involving a core task force of nine experts.

RESULTS

The consensus provides evidence-based recommendations for the screening, diagnosis, and management of MASLD in individuals with T2D. Key findings include mandatory screening for all individuals with T2D, with particular attention to those exhibiting high-risk features such as metabolic syndrome and obesity. Non-invasive tools, such as FIB-4 or vibration-controlled transient elastography, are recommended for fibrosis assessment. Management strategies encompass lifestyle modifications, pharmacological interventions, and surgical options when appropriate. The consensus also addresses specific considerations for hepatocellular carcinoma surveillance in patients with advanced fibrosis and compensated cirrhosis.

CONCLUSIONS

These consensus guidelines offer the first tailored, evidence-based recommendations for the management of MASLD in Asian Indians with T2D, addressing the unique metabolic and clinical characteristics of this population. The guidelines emphasize proactive screening, regular monitoring, and early intervention, along with a comprehensive, multi-modal treatment approach to optimize outcomes in this high-risk group.