Screening for advanced liver fibrosis due to MALSD alongside retina scanning in people with T2D

Lindfors, Andrea et al. “Screening for advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease alongside retina scanning in people with type 2 diabetes: a cross-sectional study.” The lancet. Gastroenterology & hepatology vol. 10,2 (2025): 125-137.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in people with type 2 diabetes, with global estimates around 65% in this group.

Advanced liver fibrosis is the main predictor of morbidity and mortality in MASLD.

International guidelines recommend screening for advanced fibrosis in people with type 2 diabetes, but practical implementation strategies are lacking.

Retina scanning for diabetic retinopathy is already a routine, centralized process for people with type 2 diabetes in Sweden.

To assess whether vibration-controlled transient elastography (VCTE™, e.g., FibroScan^®) for liver fibrosis can be efficiently and acceptably implemented alongside routine retina screening in people with type 2 diabetes, and to estimate the prevalence of MASLD and advanced fibrosis in this population.

Cross-sectional study at a large retina scanning facility in Stockholm, Sweden (Nov 2020–June 2023).

Participants were adults with type 2 diabetes referred for routine retina scanning.

VCTE™ was performed during waiting time for retina scan.

Increased liver stiffness: ≥8.0 kPa; advanced fibrosis: >12.0 kPa.

MASLD defined as CAP™ (controlled attenuation parameter) ≥280 dB/m.

Participants with elevated or unreliable VCTE™ referred for secondary specialist evaluation.

1005 patients (77.2%) accepted VCTE™ screening.

504/973 (51.8%) had MASLD defined by CAP™ ≥280 dB/m.

154/977 (15.8%) had liver stiffness ≥8.0 kPa (suggestive of fibrosis).

49/977 (5.0%) had liver stiffness >12.0 kPa (possible advanced fibrosis).

On repeat specialist evaluation, 56/124 (45.2%) participants with initially elevated liver stiffness had normal values (<8.0 kPa).

Final prevalence after confirmation: 74/1,005 (7.4%) had confirmed liver stiffness ≥8.0 kPa; 29/1,005 (2.9%) had >12.0 kPa.

Distribution of liver stiffness by VCTE™ (kPa) from reliable measurements in 977 participants with type 2 diabetes

• Feasibility: Screening for liver fibrosis with VCTE™ alongside retina scanning is feasible and well accepted in people with type 2 diabetes.

• High Prevalence: Over half of screened patients had MASLD; 7.4% had confirmed significant fibrosis, and 2.9% had advanced fibrosis.

• Clinical Implication: Integrating liver fibrosis screening into existing diabetes care pathways (e.g., retina clinics) can help identify patients at risk for liver-related complications, but should include a two-step VCTE™ protocol to minimize overtreatment due to false positives.

Simultaneous screening for advanced liver fibrosis using VCTE™ during routine retina scans in people with type 2 diabetes is feasible and widely accepted, enabling effective case-finding for metabolic dysfunction-associated steatotic liver disease. Authors recommend to confirm elevated VCTE™ results with a second measurement before making any clinical management decisions.