MASH linked to Increased Vascular Complications in Type 2 Diabetes: Study
USA: Researchers have found in a new study that patients with type 2 diabetes (T2D) who also have metabolic dysfunction-associated steatohepatitis (MASH) face significantly higher risks of both microvascular and macrovascular complications compared with those with T2D alone.
The findings indicate that MASH accelerates diabetes-related complications, highlighting the need for integrated screening and management strategies to identify and treat this high-risk subgroup among patients with T2D.
The coexistence of T2D and fatty liver disease is increasingly common, yet the clinical impact of MASH on diabetes-related outcomes has not been fully clarified. To address this gap, investigators conducted a large real-world retrospective cohort study to assess whether MASH further amplifies the risk of vascular complications in individuals with T2D. The study was published in Diabetes Therapy by Semiu O. Gbadamosi and colleagues from Novo Nordisk and collaborating institutions.
Using data from the Optum Clinformatics Data Mart Database spanning 2016 to 2024, the researchers identified adults diagnosed with T2D and determined the presence of MASH based on International Classification of Diseases (ICD-10-CM) diagnostic codes. Patients with both T2D and MASH were matched in a 1:1 ratio with patients who had T2D alone using propensity score matching, ensuring that baseline demographic and clinical characteristics were well balanced between the two groups.
The primary outcomes were the development of microvascular complications, such as diabetic nephropathy and neuropathy, and macrovascular complications, including coronary heart disease and peripheral artery disease. To provide robust estimates, the investigators used Fine–Gray competing risk models, accounting for death as a competing event. Additional analyses examined outcomes across subgroups defined by age and glycemic control.
The study revealed the following notable findings:
- The analysis included 7,396 matched patient pairs for microvascular outcomes and 6,207 matched pairs for macrovascular outcomes, with an average follow-up of about 2.5–3 years.
- Patients with both type 2 diabetes and MASH showed consistently higher risks of adverse outcomes compared with those with type 2 diabetes alone.
- Comorbid MASH was associated with a 19% higher hazard of microvascular complications and a 15% higher hazard of macrovascular complications.
- The increased risks persisted across multiple subgroup analyses, including patients with both well-controlled and poorly controlled glycemia.
- Age-based analyses showed that the excess risk linked to MASH was more pronounced in patients younger than 65 years, particularly for microvascular complications.
- These findings suggest a more aggressive disease course in younger patients with T2D and MASH, underscoring the value of early detection and closer clinical monitoring.
The authors acknowledged several limitations, including reliance on administrative claims data, which may lack detailed clinical information and could lead to underdiagnosis or misclassification of MASH. Additionally, changes in disease nomenclature over time may complicate comparisons with earlier studies.
Despite these limitations, the study provides compelling real-world evidence that MASH meaningfully worsens vascular outcomes in patients with T2D. The findings reinforce the importance of integrated diabetes and liver disease care, supporting routine screening for MASH in patients with T2D and the development of coordinated management strategies aimed at reducing long-term complications and improving overall outcomes.
Reference:
Gbadamosi, S.O., Shi, D., Aly, A. et al. Risk of Microvascular and Macrovascular Complications in Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatohepatitis: A Retrospective Cohort Study. Diabetes Ther (2025). https://doi.org/10.1007/s13300-025-01831-7
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