Led by Xiao-Dong Zhou and colleagues from the MASLD Research Center at Wenzhou Medical University, China, the research provides key insights into how glycemic control may influence liver health outcomes in patients with MASLD.
The study analyzed data from 7,543 patients with MASLD participating in the VCTE-Prognosis cohort, who underwent serial vibration-controlled transient elastography (VCTE) assessments and hemoglobin A1c (HbA1c) measurements over a median follow-up of 4.1 years. Among these patients, 4,090 had T2D—split evenly between well-controlled (HbA1c <7%) and poorly controlled (HbA1c ≥7%) diabetes—while 3,453 did not have T2D.
The study led to the following notable findings:
- MASLD patients with type 2 diabetes had a 50% higher risk of liver stiffness progression compared with patients without diabetes (HR 1.50).
- T2D in MASLD patients was associated with a two-fold increased risk of liver-related events (LRE) such as cirrhosis, hepatic decompensation, or hepatocellular carcinoma (HR 2.03).
- Among MASLD patients with T2D, those with good long-term glycemic control showed slower liver stiffness progression compared with those with poor control (HR 1.52).
- Glycemic control did not significantly affect liver stiffness regression.
- Glycemic control also did not alter the incidence of liver-related events, indicating that optimal blood sugar management may slow progression but may not reverse established liver damage.
“Our findings emphasize the critical role of maintaining optimal glycemic control in patients with MASLD who also have type 2 diabetes,” said the researchers. “Effective diabetes management could help slow the progression of liver stiffness, potentially reducing long-term complications, even if it does not fully reverse liver damage or prevent liver-related events.”
The study’s methodology incorporated time-weighted average HbA1c to capture both the magnitude and duration of glycemic exposure, providing a more comprehensive assessment of long-term glycemic control. Kaplan–Meier analyses and Cox proportional hazards models confirmed the robustness of the findings, which were consistent across multiple sensitivity analyses.
Given the rising prevalence of MASLD and its overlap with T2D worldwide, the authors suggest that early identification and stringent management of diabetes in MASLD patients could be a key strategy to mitigate disease progression. They also call for further prospective studies to explore interventions that may prevent liver-related complications and improve long-term outcomes in this high-risk population.
"The study demonstrates that type 2 diabetes significantly worsens liver stiffness progression and liver-related outcomes in MASLD. While optimal glycemic control can slow the progression of liver stiffness, it does not appear to affect regression or liver-related events, highlighting the importance of early management and ongoing monitoring in this patient population," the authors concluded.
Reference:
Zhou, X., Chen, Q., Kim, S. U., Yip, T. C. F., Petta, S., Nakajima, A., Tsochatzis, E., Boursier, J., Bugianesi, E., Hagström, H., Chan, W., Romero-Gomez, M., Calleja, J. L., De Lédinghen, V., Castéra, L., Sanyal, A. J., Goh, B. G., Newsome, P. N., Fan, J., . . . Zheng, M. (2025). Long-Term Glycemic Control and the Risk of Liver Stiffness Progression and Liver-Related Events in MASLD. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2025.10.003
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