Racial disparities in evidence-based management of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes

Objective To assess frequency of evidence-based management (EBM) of metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes (T2D), and to examine for racial/ethnic disparities in the receipt of EBM. Methods We conducted a cross-sectional analysis of patients with T2D and presumptive MASLD in an academic healthcare system between 2019 and 2021. Presumptive MASLD was defined as at least one ALT value ≥30 U/L with exclusions for alcohol overuse, viral hepatitis, liver transplantation, chemotherapy use, and liver disease other than MASLD. We calculated the proportion of patients receiving EBM, defined as a composite of liver ultrasound, transient elastography or hepatology evaluation. We also examined the association between race/ethnicity and EBM via a logistic regression model. Results Our sample included 6,532 patients; mean age was 58.0 (SD 13.1), 41.7% were female and 3.9%, 26.6%, 58.7% and 5.8% were of Latino/a/x ethnicity, non-Latino (NL) Black race, NL White race and NL Asian race, respectively. Rates of EBM were low overall (11.5%), with lower odds of EBM in NL Black vs. NL White patients (aOR 0.75, 95% CI 0.59, 0.96). Odds of hepatology evaluation and placement of MASLD diagnosis codes were also lower in NL Black vs. NL White patients. Conclusion Racial disparities exist in the receipt of EBM among patients with T2D and presumptive MASLD. These findings highlight the need for research to identify drivers of disparities, and to support development of clinical interventions that equitably facilitate EBM of MASLD in patients with T2D.