The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is high (i.e., 30% of the general United States population) and steadily rising.1,2 Type 2 diabetes (T2D) is a leading risk factor for the development of MASLD and progression to poor liver outcomes.3,4 Notably, patients with T2D are twice as likely as those without T2D to develop metabolic dysfunction-associated steatohepatitis (MASH),5 which is a progressive form of MASLD that can lead to cirrhosis, hepatocellular carcinoma and end-stage liver disease. Latino/a/x patients with T2D are at particularly high risk of developing progressive forms of MASLD, and Black patients may also be at higher risk of liver mortality from MASLD than White patients.6 In order to reduce MASLD-related morbidity and mortality and promote equity, there is a great need for front-line T2D providers (i.e., Primary Care, Endocrinology) to proactively identify and appropriately manage their patients at highest risk of MASH, to prevent its progression to cirrhosis and irreversible complications. To this end, the American Diabetes Association (ADA) has recommended that T2D providers conduct additional testing for MASH in patients with T2D and elevated ALT,7 e.g., liver ultrasound, transient elastography, and/or Hepatology referral when merited.

Provider surveys have identified significant gaps in knowledge regarding how to diagnose and treat patients at high risk of MASH.8,9 A gap also exists between guideline recommendations and observed clinical practice as it relates to the evaluation and management of MASLD/MASH.10,11 Yet, little is known about whether racial/ethnic disparities exist in who receives evidence-based management for MASLD. The objective of this study was to examine whether racial/ethnic disparities exist in evidence-based management of MASLD in patients with T2D.