Metabolic Dysfunction-associated Steatotic Liver Disease (MASLD)—formerly NAFLD—is a highly prevalent comorbidity in Type 2 diabetes that significantly increases the risk of cirrhosis, hepatocellular carcinoma, and cardiovascular death. These flashcards are designed to help pharmacists and healthcare professionals quickly recall the 2024 Clinical Practice Guidelines Update regarding the new nomenclature, the two-step screening algorithm for fibrosis, and the emerging pharmacotherapeutic options.
Key Topics Covered:
New Terminology: Understanding the transition from NAFLD to MASLD (Metabolic Dysfunction-associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction-associated Steatohepatitis) [cite: Ch42-Diabetes-and-Metabolic-Dysfunction-associated-Steatotic-Liver-Disease-in-Adults.pdf].
Screening Protocol: Memorizing the two-step algorithm: starting with the FIB-4 index (age, AST, ALT, platelets) every 3 years to rule out advanced fibrosis in patients with Type 2 diabetes [cite: Ch42-Diabetes-and-Metabolic-Dysfunction-associated-Steatotic-Liver-Disease-in-Adults.pdf].
Risk Stratification: Identifying the thresholds for referral: knowing that a low FIB-4 score (<1.3) allows for continued primary care management, while higher scores require second-line testing (e.g., FibroScan).
Pharmacotherapy: Recalling that GLP-1 receptor agonists and SGLT2 inhibitors are the preferred antihyperglycemic agents for patients with MASLD, and that pioglitazone has specific benefits for MASH.
Statin Use: Reinforcing that statins are safe and essential for cardiovascular protection in this population, despite potential mild elevations in liver enzymes.