Global epidemiology and characteristics of MASLD in type 1 diabetes mellitus: an updated systematic review and meta-analysis

Background and aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is often overlooked in patients with type 1 diabetes mellitus (T1DM). Our study aims to provide a comprehensive overview of the burden of MASLD in T1DM by assessing the prevalence of MASLD and its advanced forms in individuals with T1DM.

Methods: We systematically searched PubMed and Embase databases (from inception to May 5, 2024) for original articles on the prevalence or characteristics of MASLD (as detected by blood biomarkers/scores, imaging techniques or liver biopsy) in adults with T1DM. Data were extracted, and we performed meta-analysis of proportions using generalized linear mixed model, and pairwise meta-analysis using the DerSimonian-Laird method. Heterogeneity was investigated with further subgroup and meta-regression analyses, and publication bias was assessed.

Results: We identified 23 studies for a total of 13006 T1DM individuals. Of these, 22.24% (95%CI 15.62; 30.66, I²=99.2%) had MASLD. Significant fibrosis (≥F2) and advanced fibrosis (≥F3) were found in 13.25% (95%CI 11.15; 15.67, I²=0%) and 5.12% (95%CI 3.78; 6.91, I²=0%) of T1DM patients with MASLD, respectively. Patients with MASLD and T1DM were more likely to be older, overweight, male, have a longer duration of diabetes, require higher daily doses of insulin, have metabolic dysfunction and were at a higher risk of microvascular complications.

Conclusion: MASLD is relatively common in T1DM. Patients with MASLD-T1DM have a distinct clinical profile compared to those with T1DM, with only a small proportion having significant or advanced fibrosis.