Microvascular Complications of Type 2 Diabetes With or Without MASLD: A Primary Care Cohort Study

Background: Study results are heterogenous for the risk of microvascular complications of type 2 diabetes among patients with metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to explore the association between MASLD and chronic kidney disease, retinopathy, neuropathy and diabetic foot ulcers in a primary care setting. Methods: Participants with type 2 diabetes were recruited in primary care. Hepatic triglyceride content was assessed using magnetic resonance with liver proton density fat fraction (MASLD ≥ 5 %) or vibration-controlled transient elastography with controlled attenuation parameter (MASLD ≥ 248 dB/m) and hepatic fibrosis using vibration-controlled transient elastography (advanced fibrosis ≥10 kPa). Data on chronic kidney disease, retinopathy, neuropathy and diabetic foot ulcers were collected from medical health records. Results: 308 participants were included. 181 (59%) participants were defined as having MASLD. Of these, 161 (52%) had no evidence of advanced fibrosis stage while 20 (6%) were considered to have advanced fibrosis. 64 (21%) participants had neuropathy, 60 (19%) retinopathy, 59 (19%) chronic kidney disease, and 13 (4%) diabetic foot ulcers. There were no significant differences, for these complications, between participants with or without MASLD. Participants with MASLD and higher histopathological fibrosis stage had increased risk for microvascular complications. Conclusions: Our study of patients with type 2 diabetes in primary care showed that participants with concomitant MASLD did not have an increased risk for chronic kidney disease, neuropathy or retinopathy, which supports previous results of risk variation in different ethnicities and geographic locations. Trial registration: Clinical trial number NCT03864510 (registration date 2019-02-12)