Both diseases are intertwined by mechanisms such as insulin resistance, adipose tissue dysfunction, and chronic inflammation, though the exact molecular and genetic basis remains unclear. Clinical cha

The gap

Consensus across the literature

Supporting evidence — 4 representative gaps

• The Bidirectional Relationship Between Type 2 Diabetes and NAFLD/MASH: Pathophysiology, Screening Strategies, and Therapeutic Opportunities (2026) · doi

  Both diseases are intertwined by mechanisms such as insulin resistance, adipose tissue dysfunction, and chronic inflammation, though the exact molecular and genetic basis remains unclear. Clinical challenges persist in screening and diagnosing patients, as current non-invasive methods are insufficient for identifying risks of progression from simple steatosis to steatohepatitis and fibrosis. Moreover, effective treatments for both T2DM and NAFLD/MASH are lacking, with therapies mainly targeting T2DM.

  Keywords: diseases intertwined mechanisms insulin resistance adipose tissue dysfunction chronic inflammation though exact molecular genetic basis
• Association between visceral adiposity indices (VAI and LAP) and non-alcoholic fatty liver disease in type 2 diabetes mellitus: a cross-sectional analysis (2025) · doi

  This study analyzed a general sample of patients with T2DM without accounting for disease duration/ onset. Disease duration may influence severity via insulin resistance, lipid dysregulation, and changes in body weight and waist circumference. Future studies focusing on newly diagnosed T2DM may provide more precise cutoffs for diagnosing NAFLD. Authors' contributions: Conceptualization, design, materials and sources, data processing, interpretation and analysis, literature review, manuscript editing — Sukamdani Rachman; Conceptualization, planning, guidance, interpretation and analysis — Fabiola MS Adam; Conceptualization, planning, guidance, evaluation, literature review — Fardah Akil; Conceptualization, planning, guidance, evaluation, literature review — Syakib Bakri; Conceptualization, critical review, design — Nur Ahmad Tabri; Conceptualization, analysis and interpretation, critical review — Andi Alfian Zainuddin. Acknowledgements: This research was supported by the Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia. Conflict of interest: The authors declare no conflicts of interest relat- ed to this manuscript. Financial support: none declared REFERENcES 1. Lazarus JV, Mark HE, Allen AM, Arab JP, Carrieri P, Noureddin M, et al; on behalf of the Healthy Livers, Healthy Lives Collaborators. A global action agenda for turning the tide on fatty liver disease. Hepatology. 2024 Feb 1;79(2):502-523. doi: 10.1097/HEP.0000000000000545. 2. Huang JF, Chang TJ, Yeh ML, Shen FC, Tai CM, Chen JF, et al. Clinical care guidance in patients with diabetes and metabolic dysfunction- associated steatotic liver disease: A joint consensus. Hepatol Commun. 2024 Oct 30;8(11):e0571. doi: 10.1097/HC9.00000000000 00571. 3. Raza S, Rajak S, Upadhyay A, Tewari A, Anthony Sinha R. Current treatment paradigms and emerging therapies for NAFLD/NASH. Front Biosci (Landmark Ed). 2021 Jan 1;26(2):206-237. doi: 10.2741/4892. 4. Decharatanachart P, Chaiteerakij R, Tiyarattanachai T, Treeprasertsuk S. Application of artificial intelligence in non-alcoholic fatty liver disease and liver fibrosis: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2021 Dec 21;14:17562848211062807. doi: 10.1177/17562848211062807. 5. Gofton C, Upendran Y, Zheng MH, George J. MAFLD: How is it different from NAFLD? Clin Mol Hepatol. 2023 Feb;29(Suppl):S17-S31. doi: 10.3350/cmh.2022.0367. 6. Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022 Nov 1;45(11):2753-2786. doi: 10.2337/dci22-0034. 7. Popa SL, Ismaiel A, Cristina P, Cristina M, Chiarioni G, David L, Dumitrascu DL. Non-Alcoholic Fatty Liver Disease: Implementing Complete Automated Diagnosis and Staging. A Systematic Review. 340 Romanian medical JouRnal – Volume 72, no. 3, 2025

  Keywords: review disease conceptualization liver diabetes guidance nafld interpretation literature planning fatty patients duration authors design
• Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine (2020) · doi

  There are inherent limitations present in this review. The lifestyle intervention studies of T2D remission are few in number with wide variability of design as well as being generally limited to short-term outcomes. A majority of the therapeutic studies examined would not meet the definition of remission put forth by Buse et al,11 though there is a lack of consensus on duration needed to assess remission among clinicians and researchers.12 Most studies of remission have examined T2D of short duration, and success rates are higher the earlier treatment is initiated after diagnosis. This is not a systematic review; the list of studies (Tables 1-3) is not exhaustive but rather chosen to be representative of the position statement put forth.

  Keywords: remission there review short examined forth duration inherent limitations present lifestyle intervention number wide variability
• Determinants of LDL-C target non-attainment in patients with type 2 diabetes at very high cardiovascular risk: a cross-sectional analysis of central obesity and metabolic factors (2026) · doi

  Future studies should validate these findings in larger, prospective cohorts and evaluate interven- tions targeting central obesity and treatment adher- ence. A multidisciplinary approach should be ex- plored to optimize lipid management in high-risk patients with type 2 diabetes. CONCLUsION In this study of Vietnamese patients with T2DM at very high CV risk, central obesity emerged as an independent factor associated with LDL-C non-at- tainment despite statin therapy. These findings sug- gest that lipid goal failure is not merely explained by inadequate pharmacological intensity but also re- flects underlying metabolic and behavioral barri- ers. Addressing these factors through comprehen- sive strategies – including weight reduction, central obesity management, and lifestyle modification support – may be essential to optimizing LDL-C con- trol and reducing residual cardiovascular risk in this vulnerable population. Ethics and consent to participate: The study was approved by the Ethics Committee for Biomedical Research of Pham Ngoc Thach University of Medicine (No. 986/TĐHYKPNT–HĐĐĐ, January 4, 2024) and the Ethics Committee for Biomedical Research of Nguyen Tri Phuong Hospital (No. 816/NTP–HĐĐĐ, April 22, 2024). Written informed consent was obtained from all participants prior to enrollment. Authors’ contributions: All authors contributed to the conception and overall content of the manuscript. Tri Minh Bui – writing—original draft, literature review; Loc Phuc Tran, Thao Thi Thu Nguyen, Ngoc Tran Minh Vo – literature review; Hung Cao Dinh – writing—review and editing, language editing. All authors reviewed and approved the final ver- sion of the manuscript. Conflict of interest: The authors declare that there are no conflicts of interest related to the research, authorship, or pub- lication of this manuscript. Financial support: The authors received no financial support for the conduct of this research, the authorship, or the pub- lication of this manuscript. Acknowledgments: The authors thank to all members of the Endocrine Department at Nguyen Tri Phuong Hospital, Ho Chi Minh City, for their collaboration, and are deeply grateful to all study participants for their invaluable contribution. 104 rEFErENCEs 1. Gourdy P, Schiele F, Halimi JM, Kownator S, Hadjadj S, Valensi P. Atherosclerotic cardiovascular disease risk stratification and management in type 2 diabetes: review of recent evidence-based guidelines. Front Cardiovasc Med. 2023 Sep 26;10:1227769. doi: 10.3389/fcvm.2023.1227769. 2. Breuker C, Clement F, Mura T, Macioce V, Castet-Nicolas A, Audurier Y, et al. Non-achievement of LDL-cholesterol targets in patients with diabetes at very-high cardiovascular risk receiving statin treatment: Incidence and risk factors. Int J Cardiol. 2018 Oct 1;268:195-199. do

  Keywords: risk authors manuscript review central obesity management high patients diabetes support cardiovascular ethics nguyen minh