Background MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steato Hepatitis) have an increasingly important role in metabolic diseases. The prevalence of MASLD is 70-80% in patients with type 2 diabetes mellitus (T2DM). MASLD is associated with a greater risk of progression to severe fibrosis, cirrhosis and hepatocellular carcinoma. Materials and methods Our study evaluated the degree of liver fibrosis by sheare wave elastography in an unselected group of 1,160 outpatients with T2DM, after one year of lifestyle modifications and pharmacological treatment, where indicated. Results Average age was 63 ± 11 years and average body mass index (BMI) 27 ± 5.7 kg/mq. Most patients (43%) were overweight and 23% were obese: 17% I grade of obesity (BMI 30-34.9 kg/mq), 5% II grade (BMI 35-39.9 kg/mq) and 1% III grade (BMI >40 kg/mq). Average glycated hemoglobin value was 7.0 ± 0,95% (HbA1c range 5-13,6%). Total cholesterol, HDL cholesterol, triglycerides, creatinine and liver enzymes were regular. In the second evaluation with elastography, a statistically significant reduction (p<0.0001) in F3 fibrosis (from 10.1% to 2.5%) and in F2 to F0/F1 (from 50.4% to 23.8%) was observed, while cases of F4 fibrosis increased (from 1.9% to 3.5%). The statistically significant reduction in the degree of fibrosis in the population seems to be related to a statistically significant increase (p=0.002) in the use of SGLT2i, GLP-1RA and associated therapy of the two pharmaceutical classes. Conclusions It is particularly important screening diabetic population for MAFLD using non-invasive methods to establish targeted treatments with drugs of proven efficacy. Antidiabetic drugs have been shown to be effective in achieving glycemic targets, but also in preventing hepatological complications. The combined use of SGLT2i and GLP-1RA could lead to a beneficial additive effect on MASLD. However, further studies are needed to confirm these results and determine the most effective therapeutic strategy.

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Key words: MASLD, MASH, T2DM , liver fibrosis, sheare wave elastography, SGLT2i, GLP-1RA