Introduction and Objective: Despite its systemic impact, MASLD is often overlooked in routine T2DM care. Our study evaluates whether glycemic status and the NFS are associated with the prevalence and severity of microvascular complications in hospitalized patients with T2DM.Methods: Our retrospective cross-sectional study analyzed data from 4,009 hospitalized patients with T2DM in Almaty, Kazakhstan (2017-2019). Inclusion required confirmed T2DM and complete laboratory records. Patients with type 1 diabetes, secondary liver steatosis (alcohol, hepatitis), and end-stage renal failure were excluded. Diagnosis of MASLD using ultrasound and clinical evaluation. Assessment of fibrosis stage using NFS, and glycemic control via HbA1c. The primary outcomes were retinopathy (fundus examination) and diabetic kidney disease (DKD, eGFR). Statistical analysis, including Pearson’s χ² and logistic regression (OR; 95% CI), was performed using IBM SPSS Statistics (v. 26.0).Results: The prevalence of MASLD was 84.4% (n = 3,382). Notably, patients with MASLD experienced greater glycemic decompensation (HbA1c ≥8.0%) than those without (96.0% vs. 89.3%, p<0.0001). Advanced fibrosis (F3-F4) was present in 25.5% of patients and was strongly associated with elevated HbA1c levels (p < 0.0001). Furthermore, MASLD and advanced fibrosis were associated with a 2.45-fold increased risk of diabetic retinopathy (DR) (OR 2.45; 95% CI 2.04-2.94), particularly in the proliferative stages. Stage 3 DKD was also more prevalent in the MASLD group (19.3% vs. 14.8%, p = 0.007).Conclusion: In this hospitalized population, poor glycemic control and elevated NFS are significant indicators of progressive microvascular damage. Notably, liver fibrosis is associated with a 2.5-fold increased risk of retinopathy. These findings suggest that integrated MASLD screening may help identify T2DM patients at high risk for irreversible complications and disability.
B. Sultanova: None.
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