# Metabolic Dysfunction-Associated Steatotic Liver Disease in People with Type 1 Diabetes

## TL;DR

This paper reviews how fatty liver disease affects people with type 1 diabetes and its connection to insulin resistance and diabetes complications.

## Contribution

The paper clarifies the emerging role of insulin resistance in MASLD among people with type 1 diabetes and highlights new diagnostic markers like estimated glucose disposal rate.

## Key findings

- MASLD in T1D is linked to microvascular and macrovascular complications like nephropathy and cardiovascular disease.
- Estimated glucose disposal rate is a promising marker for understanding insulin resistance in T1D-related MASLD.
- Diagnostic challenges in MASLD prevalence highlight the need for standardized non-invasive methods.

## Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a significant comorbidity in individuals with type 1 diabetes (T1D), despite its historical association with type 2 diabetes. This review focuses on summarizing current findings regarding the role of insulin resistance in the development of MASLD in T1D, as well as examining the relationship between MASLD and diabetes-related complications. We will also briefly discuss the prevalence, diagnostic challenges, associated complications, and potential mechanisms underlying MASLD in T1D. Although insulin resistance is well established in MASLD among those with type 2 diabetes, its role in T1D requires further clarification. Emerging markers, such as the estimated glucose disposal rate, offer early insight into this relationship. MASLD in T1D is linked to both microvascular and macrovascular complications, including nephropathy, retinopathy, neuropathy, and cardiovascular disease. Variability in prevalence estimates reflects inconsistencies among imaging modalities, emphasizing the need for standardized, non-invasive diagnostic approaches. Recognizing and addressing MASLD and its links to insulin resistance and diabetes complications in T1D is vital for mitigating long-term complications and enhancing clinical outcomes.