Understanding the connection between type 2 diabetes and fatty liver disease
If you're living with both diseases, know that more help is available than ever
Written by |
“Do you have diabetes?”
I was sitting in one of those crunchy paper exam-room gowns, going through the usual rigmarole of questions you’re asked while waiting for your doctor. It was during my regular annual physical, and the question always annoyed me.
“Why does everyone ask that question?” I asked the doctor’s assistant, who was clicking away at the keyboard.
“Oh, well, your glucose was a little elevated, and your illness is why we ask.”
The illness, of course, was metabolic dysfunction-associated steatohepatitis (MASH). It was years ago, and I had only recently learned that my fatty liver disease had progressed to MASH. I was a little scared.
Luckily, that blood glucose test had not been a fasting one. I admitted to consuming a tall, fancy latte from one of the chain coffee shops on the hospital’s ground floor, along with a sugary snack. When my doctor came into the room, she allayed my fears and ordered a fasting test for the following week.
The results were in my favor: No diabetes detected.
MASH and diabetes
It feels like I go through these emotions a lot. I don’t have a close relative, living or dead, who was ever diagnosed with type 2 diabetes. I do have relatives with MASH, though, so could I become an outlier? I really hope not.
If you’re one of those MASH patients dealing with diabetes, I can assure you that although I don’t have it, plenty of people do. It can be one of the harder things a MASH patient faces.
The fact is, MASH and type 2 diabetes have what researchers call a “synergistic, bidirectional relationship.” In plain English, the two diseases share important metabolic risk factors, including obesity and insulin resistance, and each can complicate the other. Having one does not mean you will inevitably develop the other, but the overlap is significant.
Inflammation is part of that picture, too. The word hepatitis basically means liver inflammation. MASH involves liver fat, inflammation, and injury, while type 2 diabetes is driven by problems with insulin production and insulin resistance. When both occur together, the risks of liver fibrosis and other complications can increase.
It’s easy to give up hope when facing two major diseases, but there is more help available than ever.
Unless you’ve just emerged from a Rip Van Winkle-like sleep of 20 years, you’ve probably heard about GLP-1 receptor agonists. Originally developed to treat diabetes, these drugs have become one of the 21st century’s biggest medical stories. They can help control blood sugar and, for some people, support substantial weight loss. Some also have cardiovascular benefits.
And now there is important liver news: In 2025, the U.S. Food and Drug Administration approved Wegovy (semaglutide) to treat MASH in certain adults with moderate to advanced fibrosis who do not yet have cirrhosis.
Personally, I’ve been impressed by these drugs. I recently discussed them with my liver doctor, who believes they can be useful for some MASH patients. He was happy to recommend that I explore whether one might be appropriate for me.
I’m now working with my primary care doctor to see if I qualify for Medicare’s new GLP-1 Bridge program because of my weight and history of heart disease. The program launched July 1 and offers certain eligible Medicare Part D beneficiaries covered GLP-1 medications for a $50 monthly copay through Dec. 31, 2027. Eligibility depends on specific medical criteria, and the Bridge program has different rules from ordinary Part D coverage. Check with your doctor and Medicare to see what applies.
Medication isn’t the only tool. Regular physical activity can benefit liver health even without weight loss, and federal guidelines recommend working toward at least 150 minutes of moderate activity per week when you’re able. Even starting with a short walk and building from there counts.
Food choices matter, too. I try to choose higher-fiber, less-refined carbohydrates that digest more slowly instead of foods that send my blood sugar on a roller coaster. Personally, I’m a fan of sweet potatoes, so I’m happy to make that switch whenever I can. Just remember that candied yams swimming in sugar and butter are a different nutritional creature entirely.
I’m still a little jumpy when someone asks whether I have diabetes. At least now I understand why the question matters and that there are more ways than ever to prevent, treat, and manage metabolic disease.
For everyone who reads this column and lives with MASH and type 2 diabetes, I wish you health, happiness, and well-controlled blood sugar. Keep asking questions. Keep working with your doctors. And keep taking the next manageable step.
Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.
Leave a comment
Fill in the required fields to post. Your email address will not be published.