Markers Of Insulin Resistance and Their Clinical Implications In Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatotic Liver Disease

Background: Insulin resistance, type 2 diabetes (T2D), and metabolic dysfunction-associated steatotic liver disease (MASLD) are pathogenically interconnected conditions, being part of a dysfunctional metabolic continuum that explains the high frequency of MASLD in patients with T2D. Purpose: The present study evaluated the prevalence of MASLD in patients with T2D and identified key risk factors. We correlated MASLD with insulin resistance and other cardiovascular risk factors to determine cutoff values for increased hepatic steatosis risk. Methods: We cross-sectionally evaluated 256 T2D patients (median age 63.5 years, 54.3% female) admitted to a regional diabetes center. MASLD diagnosis was based on FibroScan Echosens and standard clinical criteria. We recorded comorbidities and metabolic parameters, and calculated insulin resistance indexes, including TyG and METS-IR scores. We correlated MASLD with insulin resistance and other cardiovascular risk factors to determine cutoff values for increased hepatic steatosis risk. Results: MASLD was present in 87.5% (95% CI: 76.4-99.7) of patients. TyG index and METS-IR showed statistically significant associations with MASLD presence, and ROC analysis indicated moderate discrimination (AUC values 0.80-0.86). ROC analysis identified HbA1c >7.2% as a discriminative threshold for MASLD, but predictive accuracy was modest (AUC 0.696). Conclusion: In patients with T2D, suboptimal glycemic control and insulin resistance are associated with MASLD and fibrosis. Insulin resistance markers, TyG and METS-IR, were significantly associated with MASLD and showed moderate discriminative capacity in ROC analysis, suggesting potential value for screening. Incorporating these indices into routine assessment may improve identification of high-risk patients and guide timely interventions to prevent disease progression.