INSULIN resistance has been independently linked to metabolic dysfunction-associated steatotic liver disease (MASLD) in adults with type 1 diabetes (T1D), according to new clinical data.
The findings point to a distinct, higher-risk metabolic phenotype. MASLD, a condition characterised by excess fat accumulation in the liver, affects around a quarter of the global population, though prevalence in T1D is estimated at 16–20%.
Despite people with T1D historically showing lower susceptibility to insulin resistance, a subgroup of patients may develop a more adverse metabolic profile. Sometimes described as ‘double diabetes’, this is where T1D coexists with insulin resistance.
A Clearer Picture of Insulin Resistance in MASLD
While insulin resistance is a well-established metabolic driver of MASLD in the general population, its role in T1D has remained less clear. This study addressed this gap using gold standard methods to assess both liver fat content and insulin sensitivity.
Researchers analysed 39 adults with T1D and relatively controlled glycaemia. Participants were stratified according to liver fat content, measured using magnetic resonance spectroscopy, with MASLD defined at a threshold above 5.56%.
Whole-body insulin sensitivity was quantified using the hyperinsulinaemic-euglycaemic clamp, a controlled method that measures how effectively glucose is cleared from the bloodstream under steady insulin levels.
Strong Association Independent of Traditional Risk Factors
Participants with MASLD had markedly higher liver fat content and significantly lower insulin sensitivity. The mean glucose disposal rate was less than half in the MASLD group compared with those without liver disease.
A strong inverse correlation was observed between liver fat content and insulin sensitivity, and this relationship remained significant after adjusting for body mass index, waist circumference, age, lipid levels, insulin dose and genetic predisposition.
Additional measures of insulin sensitivity, including breath testing and estimated glucose disposal rates, showed consistent associations with MASLD, reinforcing the robustness of the findings.
Patients with MASLD also displayed features of metabolic syndrome, including higher body mass index, elevated triglycerides, lower HDL cholesterol and increased systolic blood pressure, alongside poorer glycaemic control despite higher insulin dosing.
Limitations and Implications for Care
The study’s small sample size and cross-sectional design limit conclusions about causality. Although the observed differences in insulin resistance were large, longitudinal data are needed to determine whether insulin resistance directly drives MASLD progression in T1D.
Current European guidance does not recommend routine MASLD screening in T1D, partly due to inconsistent evidence and limitations in available diagnostic tools. These findings may inform future risk stratification, particularly for identifying patients with a more adverse metabolic phenotype.
Further research is needed to assess whether improving insulin sensitivity could reduce liver fat content and alter disease trajectory in this population.
Reference
Mertens J et al. Elevated liver fat content is independently associated with insulin resistance in people with type 1 diabetes. JHEP Rep. 2026;DOI:10.1016/j.jhepr.2026.101887.
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