Comparison of metabolic dysfunction-associated steatotic liver disease characteristics in patients with type 1 and 2 diabetes mellitus

Abstract

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is related to metabolic syndrome (MetS) and type 2 diabetes (T2DM). An association between type 1 diabetes (T1DM) and MASLD is not extensively investigated. Therefore, this study investigated the prevalence and risk factors for MASLD in T1DM compared to T2DM. Method: In this Belgian prospective cross-sectional study, MASLD was evaluated via transient elastography (VCTE) for fibrosis and controlled attenuation parameters (CAP) for steatosis (FibroScan ® , Echosens). The cutoff values >248 dB/m for steatosis and 8 kPa for fibrosis were used. MASLD was defined as steatosis with at least one cardiometabolic risk factor, not including the glucose criterium for the T1DM group. Excessive use of alcohol was excluded. Insulin sensitivity was calculated via estimated Glucose Disposal Rate (eGDR) and SEARCH estimated Insulin Sensitivity (eIS). Associations were explored separately in T1DM and T2DM through logistic regression and compared between groups via interaction analysis. Results: 66 T1DM (mean age 57 ± 11.5 years, 61% male, body mass index (BMI) 26.6 ± 4.06 kg/m 2) and 290 T2DM patients (median age 61 [55.0-68.0] years, 57% male, BMI 31.7 [28.8-35.7] kg/m 2) were included. MASLD prevalence was 39% in T1DM and 83% in T2DM, with statistically significantly higher VCTE and CAP in T2DM (p < 0.001). eIS and eGDR were statistic significantly higher in T1DM compared to T2DM (p < 0.001). Waist circumference (OR 1.20 (95% CI 1.09-1.32), 1.18 (95% CI 1.08-1.29)), BMI (OR 1.59 (95% CI 1.23-2.06), 1.52 (95% CI 1.24-1.86)), and MetS (OR 3.11 (95% CI 0.73-12.23), 33.1 (95% CI 5.86-186.7)) were positively associated with MASLD in T1DM and T2DM, respectively. Better insulin sensitivity through eIS (OR 0.29 (95% CI 0.15-0.59), 0.48 (95% CI 0.29-0.79)) and eGDR (OR 0.68 (95% CI 0.52-0.90), 0.61 (95% CI 0.43-0.87)) was negatively associated with MASLD in T1DM and T2DM, respectively. Factors were adjusted for age, sex and diabetes duration. Conclusion: MASLD is less prevalent and advanced in patients with T1DM compared to patients with T2DM. Classic metabolic risk factors are associated with MASLD in both T1DM with insulin resistance and T2DM. Further studies are needed to validate these findings and analyse the onset of double diabetes. POSTER PRESENTATIONS S611 Journal of Hepatology 2026 vol. 84S1 | S69-S981