Spotlight on Liver Health:
What the ADA’s New Guidelines Mean for People with Diabetes
June 2025 – The American Diabetes Association (ADA) has released new guidance that shines a spotlight on a long-overlooked concern: liver health in people with type 2 diabetes and prediabetes.
At our GI clinic, we’re committed to helping patients and healthcare partners understand the implications of this important shift — and how early action can lead to better long-term outcomes.
Why the Liver Deserves Attention in Diabetes Care
Did you know that nearly 70% of people with type 2 diabetes also have MASLD — Metabolic dysfunction–Associated Steatotic Liver Disease (previously called “fatty liver disease”)?
MASLD is more than just excess fat in the liver. For nearly half of these patients, it can progress to MASH (Metabolic dysfunction–Associated Steatohepatitis), which involves inflammation and scarring of the liver. If left untreated, it can lead to:
Cirrhosis
Liver cancer
Even liver failure
Despite how common and serious it is, MASLD hasn’t received the same attention as kidney damage or eye complications — until now. The ADA’s new guidelines officially recognize the liver as a target organ in diabetes care.
How Screening Works: Know Your FIB-4 Score
The ADA now recommends screening every person with type 2 diabetes or prediabetes for MASLD.
The good news? Screening starts with lab results you probably already have:
Age
Liver enzymes (AST and ALT)
Platelet count
These are used to calculate a FIB-4 score, which estimates the risk of liver fibrosis (scarring):
Here’s what the results mean:
Low Risk (FIB-4 < 1.3): Monitor every 1–2 years + focus on lifestyle
Intermediate Risk: Get a FibroScan or ELF blood test
High Risk (FIB-4 > 2.67): Refer to a liver specialist (hepatologist)
What Can You Do Right Now?
Lifestyle changes are still the most powerful treatment for early MASLD. A 7–10% weight loss can significantly reduce liver fat and inflammation — and even just 5% makes a meaningful difference.
Our top recommendations:
Focus on a Mediterranean-style or low-carb diet
Get at least 150 minutes of moderate exercise per week (like brisk walking)
Avoid alcohol, especially if inflammation is present
Seek behavioral support from a health coach or nutritionist
We’ll work with you to create a plan that’s realistic, supportive, and sustainable.
What About Medication?
While no medications are officially FDA-approved specifically for MASLD (yet), several existing drugs show real promise:
GLP-1 receptor agonists (e.g., semaglutide, tirzepatide): Improve blood sugar, promote weight loss, and benefit liver health
Pioglitazone: An affordable generic that may reduce liver scarring
Resmetirom: Approved in 2024 for advanced MASH, though access may be limited due to cost
In most cases, the best approach combines medication and lifestyle changes — and we’re here to help you navigate your options.
Team-Based Care: A New Standard
This new guidance encourages a collaborative care model, where each provider plays a role:
Primary care and endocrinologists should include MASLD screening alongside routine diabetes checkups
Dietitians, diabetes educators, and behavioral counselors offer essential lifestyle coaching
GI specialists and hepatologists are involved early for patients at high risk
What We’re Doing at Our Clinic
We’ve already integrated this guidance into how we care for patients with diabetes and prediabetes. Our approach includes:
Annual FIB-4 scoring for all eligible patients
Personalized lifestyle support through diet and exercise planning
Medication reviews to align diabetes and liver health goals
Streamlined referrals to hepatologists when needed
A Final Word: Your Liver Matters
This isn’t just another update — it’s a major step forward in preventing liver disease before it becomes life-threatening.
If you or someone you love has diabetes or prediabetes, now is the time to ask:
How’s your liver doing?
Let’s catch problems early, support you with the right tools, and build a healthier future — together.
Want to learn more or schedule a screening?
(662) 280-8222 or Book an Appointment Online
Sources:
ADA Consensus Statement on MASLD (Diabetes Care, May 2025)
American Liver Foundation
ClinicalTrials.gov