Background <p>Hepatic fibrosis is a potential marker of the severity and outcome of non-alcoholic fatty liver disease (NAFLD). The objective of our study was to evaluate the diagnostic performance of non-invasive hepatic indices (FIB-4, APRI, and AST/ALT ratio) compared with FibroScan for assessing the stage of fibrosis in individuals with NAFLD and T2DM.</p> Methods <p>This cross-sectional study was conducted including patients with NAFLD and T2DM at Cumilla Diabetic Hospital from January to December 2024. The FIB-4, APRI, and AST/ALT ratio were calculated and their correlation with FibroScan score were evaluated using Spearman’s rank correlation. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance.</p> Results <p>We included 255 patients (mean age 45&#xa0;years) with 71% F1 stage, 8.6% F2 stage, 11.8% F3 stage and 8.6% F4 stage fibrosis. A moderate correlation between FibroScan and FIB-4 (<i>r</i> = 0.62, <i>p</i> &lt; 0.05) and a weak correlation with APRI (<i>r</i> = 0.16, <i>p</i> &lt; 0.05) were observed, with no significant correlation to the AST/ALT ratio (<i>r</i> = 0.08, <i>p</i> &gt; 0.05). FIB-4 showed an AUC of 0.73 (95% CI: 0.65–0.81), with a sensitivity of 80.87% and specificity of 56.24% while APRI showed an AUC of 0.76 (95% CI: 0.69–0.84) with a sensitivity of 80.84% and specificity of 63.18%. The AST/ALT ratio had the lowest AUC (0.58), with 44.29% sensitivity and 72.93% specificity.</p> Conclusion <p>FIB-4 was the most reliable non-invasive tool for detecting advanced fibrosis in patients with NAFLD and T2DM.</p>