Better control of lifestyle and metabolic risk factors may significantly reduce the burden of severe liver disease in people with T2D. A cohort study published in BMJ Open Diabetes Research & Care evaluated the association between controlled risk factors and liver outcomes in patients with (T2D). 307,688 UK Biobank participants. Participants were analyzed, with control defined across nine domains: diet, smoking, drinking, exercise, sedentary behavior, body mass index, glycated hemoglobin, blood pressure, and LDL cholesterol.

Over a median follow-up of 12.5 years (IQR 11.8–13.2), 519 participants with T2D and 2,718 without diabetes developed severe (MASLD). Patients with T2D had nearly a fourfold risk of severe MASLD compared with non-diabetic participants (HR 3.93, 95% CI 3.56–4.33). However, excess risk decreased progressively with an increasing number of controlled risk factors, ranging from HR 5.44 to HR 2.61. Similar trends were observed for major adverse liver outcomes (MALO).

The findings highlight that patients with T2D who maintain more guideline-recommended risk factors within target ranges have progressively lower risks of severe MASLD and adverse liver outcomes. Comprehensive interventions addressing both metabolic and lifestyle factors may therefore play a key role in reducing liver complications in diabetes.