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Introduction <p>Although there is a recognized negative interplay between metabolic dysfunction-associated steatohepatitis (MASH) and type&#xa0;2 diabetes (T2D), the extent to which comorbid MASH exacerbates T2D complications is not well understood. This real-world cohort study evaluated whether the coexistence of these diseases is associated with increased risk of microvascular and macrovascular complications.</p> Methods <p>We identified eligible adults with T2D from the Optum<sup>®</sup> Clinformatics<sup>®</sup> Data Mart Database (2016–2024). Presence of MASH was determined using International Classification of Diseases, Tenth Revision, Clinical Modification coding, requiring ≥ 1 primary inpatient or outpatient diagnosis code. Patients with T2D and MASH were matched 1:1 with patients with T2D without MASH using propensity score matching to balance baseline characteristics. Fine–Gray models were used to estimate subdistribution hazard ratios (sHR) comparing the risk of microvascular and macrovascular T2D complications between both groups, while accounting for death as a competing risk. Stratified analyses were performed by glycemic control (glycated hemoglobin &lt; 7% and ≥ 7%) and age (&lt; 65 and ≥ 65&#xa0;years).</p> Results <p>The study comprised 7396 and 6207 matched pairs in the microvascular and macrovascular complications cohorts, respectively. In this T2D population, mean (standard deviation) follow-up was 2.8 (2.0) years for patients with MASH and 2.4 (1.8) years for patients without MASH in both cohorts. Compared with patients with T2D without MASH, those with T2D and MASH had increased hazards of microvascular (sHR 1.19 [95% confidence interval (CI) 1.12–1.26]) and macrovascular complications (sHR 1.15 [95%&#xa0;CI 1.08–1.23]). A similar trend was observed for the stratified subgroup analyses.</p> Conclusion <p>Patients with T2D and MASH had higher hazards of microvascular and macrovascular complications versus those with T2D without MASH. These findings suggest that the presence of MASH accelerates T2D-related complications, creating a clinical imperative for integrated screening and management approaches to identify this high-risk population among patients with T2D.</p>

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Risk of Microvascular and Macrovascular Complications in Patients with Type 2 Diabetes and Metabolic Dysfunction-Associated Steatohepatitis: A Retrospective Cohort Study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月24日

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  • Semiu O. Gbadamosi,
  • David Shi,
  • Abdalla Aly,
  • Caichen K. Zhong,
  • Husam Albarmawi,
  • Aidan McGovern,
  • Anthony Hoovler,
  • Carlos Campos

摘要

Introduction

Although there is a recognized negative interplay between metabolic dysfunction-associated steatohepatitis (MASH) and type 2 diabetes (T2D), the extent to which comorbid MASH exacerbates T2D complications is not well understood. This real-world cohort study evaluated whether the coexistence of these diseases is associated with increased risk of microvascular and macrovascular complications.

Methods

We identified eligible adults with T2D from the Optum® Clinformatics® Data Mart Database (2016–2024). Presence of MASH was determined using International Classification of Diseases, Tenth Revision, Clinical Modification coding, requiring ≥ 1 primary inpatient or outpatient diagnosis code. Patients with T2D and MASH were matched 1:1 with patients with T2D without MASH using propensity score matching to balance baseline characteristics. Fine–Gray models were used to estimate subdistribution hazard ratios (sHR) comparing the risk of microvascular and macrovascular T2D complications between both groups, while accounting for death as a competing risk. Stratified analyses were performed by glycemic control (glycated hemoglobin < 7% and ≥ 7%) and age (< 65 and ≥ 65 years).

Results

The study comprised 7396 and 6207 matched pairs in the microvascular and macrovascular complications cohorts, respectively. In this T2D population, mean (standard deviation) follow-up was 2.8 (2.0) years for patients with MASH and 2.4 (1.8) years for patients without MASH in both cohorts. Compared with patients with T2D without MASH, those with T2D and MASH had increased hazards of microvascular (sHR 1.19 [95% confidence interval (CI) 1.12–1.26]) and macrovascular complications (sHR 1.15 [95% CI 1.08–1.23]). A similar trend was observed for the stratified subgroup analyses.

Conclusion

Patients with T2D and MASH had higher hazards of microvascular and macrovascular complications versus those with T2D without MASH. These findings suggest that the presence of MASH accelerates T2D-related complications, creating a clinical imperative for integrated screening and management approaches to identify this high-risk population among patients with T2D.