CHARACTERISTICS OF THE COURSE AND TREATMENT OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND METABOLIC LIVER DISEASE

Resume. Relevance. Metabolic-associated steatohepatitis (MASLD) affects up to 38% of the global adult population and more than 70% of individuals with type 2 diabetes (T2D). The comorbidity of these conditions dramatically increases the risks of cirrhosis, hepatocellular carcinoma, and cardiovascular events. Objective. Based on data from international consensus statements, meta-analyses, and randomized clinical trials from 2020–2026, to conduct a systematic analysis of the pathogenesis, epidemiology, diagnosis, clinical course, and current treatment principles for MASLD in patients with T2D. Methodology. Search and analysis of publications in the PubMed/MEDLINE, Cochrane Library, and Embase databases from 2020–2026 using the keywords MASLD, MASH, NAFLD, T2DM, liver fibrosis, GLP-1 agonists, SGLT-2 inhibitors, and resmetirom. More than 40 primary sources were included. Key findings. The transition from the NAFLD concept to MASLD marked a fundamental pathophysiological shift. Insulin resistance defines a bidirectional vicious cycle with T2DM. Non-invasive screening (FIB-4, VCTE) should be routine for all patients with T2DM. Semaglutide received FDA approval for MASLD (2025); resmetirom became the first targeted drug; tirzepatide and retatrutide form the next wave of therapy. Keywords: type 2 diabetes, NAFLD, MASLD, MASL, insulin resistance, FIB-4, transient elastography, semaglutide, GLP-1, SGLT-2, resmetirom, tirzepatide, liver fibrosis, cardiovascular risk.

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