# Microvascular complications of type 2 diabetes with or without MASLD: the EPSOMIP study, a primary care cohort study

## TL;DR

This study found no increased risk of microvascular complications in type 2 diabetes patients with MASLD in a primary care setting.

## Contribution

The study provides new evidence on MASLD and diabetes complications in primary care, contrasting with previous specialist-based findings.

## Key findings

- No significant differences in microvascular complications between participants with and without MASLD.
- Higher fibrosis stage in MASLD was linked to increased complication risk.
- Supports variation in diabetes complication risk across ethnicities and regions.

## Abstract

Previous studies have shown inconsistent results for the microvascular complication risk in patients with type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD). In addition, many of these studies have been done in specialist care setting. We therefore aimed to explore the association between MASLD and chronic kidney disease, retinopathy, neuropathy, and diabetic foot ulcers in a primary care setting.

Participants with type 2 diabetes were recruited in primary care. Hepatic triglyceride content was assessed using magnetic resonance imaging with liver proton density fat fraction (MASLD ≥ 5%) or vibration-controlled transient elastography with controlled attenuation parameter (MASLD ≥ 248 dB/m), and hepatic fibrosis was assessed using vibration-controlled transient elastography (advanced fibrosis ≥ 10 kPa). Data on chronic kidney disease, retinopathy, neuropathy, and diabetic foot ulcers were collected from medical records.

A total of 308 participants were included. The median duration of diabetes was 7 years (IQR 3–13). MASLD was present in 181 participants (58.8%). Of these, 161 (52.3%) showed no evidence of advanced fibrosis, while 20 (6.5%) were assessed as having advanced fibrosis. Neuropathy was present in 64 participants (20.8%), retinopathy in 60 (19.5%), chronic kidney disease in 59 (19.2%), and diabetic foot ulcers in 13 (4.2%). No significant differences in these complications were observed between participants with and without MASLD. However, participants with MASLD and a higher histopathological fibrosis stage had an increased risk of microvascular complications in our study.

Participants with type 2 diabetes and concomitant MASLD recruited in primary care, did not have an increased risk of chronic kidney disease, neuropathy, or retinopathy, supporting previous findings of risk variation across different ethnicities and geographic locations.

Clinical trial number NCT03864510 (registration date 2019-02-12).

The online version contains supplementary material available at 10.1186/s12875-025-03096-2.