A novel approach combining liver screening with routine retina scans for people with type 2 diabetes (T2D) has shown a high acceptance rate and potential for early detection of advanced liver fibrosis due to metabolic dysfunction-associated steatotic liver disease (MASLD). Conducted in Stockholm, Sweden, the study assessed the feasibility of simultaneous vibration-controlled transient elastography (VCTE) during retina screening visits.

      From November 2020 to June 2023, 1301 eligible participants were offered liver stiffness assessments via vibration-controlled transient elastography (VCTE) during their retina scanning appointments. The study excluded individuals with type 1 diabetes, known liver disease, high alcohol consumption, pregnancy, or inability to speak Swedish. A total of 1005 participants (77.2%) accepted the screening, with reliable liver stiffness measurements obtained for 973 (96.8%).

      The findings revealed that 504 participants (51.8%) had controlled attenuation parameter (CAP) values ≥280 dB/m, indicative of MASLD. Elevated liver stiffness (≥8.0 kPa) suggestive of fibrosis was identified in 154 participants (15.8%), while 49 individuals (5.0%) showed values >12.0 kPa, suggesting possible advanced fibrosis. However, secondary evaluations conducted by liver specialists revealed that 45.2% of participants initially flagged for elevated stiffness had values <8.0 kPa, highlighting a high rate of false-positive results. Ultimately, 7.4% of participants had confirmed liver stiffness ≥8.0 kPa, with 2.9% showing values >12.0 kPa.

      This study demonstrates the practicality of combining VCTE with retina screening in a clinical setting, achieving high participant acceptance and detecting significant rates of MASLD and fibrosis. However, the findings underscore the importance of secondary evaluations to address false positives, ensuring accurate diagnosis and appropriate management.

      The integration of liver fibrosis screening with routine diabetes care offers a potential strategy for early identification of MASLD in people with type 2 diabetes. Further research is warranted to refine the approach, improve diagnostic accuracy, and evaluate long-term outcomes in managing liver disease alongside diabetes complications.

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