Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with type 2 diabetes mellitus (T2DM). MASLD and its associated liver fibrosis contribute to the onset and progression of T2DM through the induction of insulin resistance and direct disruption of hepatic glycogen synthesis. Additionally, MASLD significantly elevates cardiovascular risk and mortality in patients with T2DM, mediated by abnormality of vascular endothelial factors and dyslipidemia resulting from insulin resistance, as well as hypercoagulability. In terms of pharmacological treatment, certain novel multi-target hypoglycemic agents have been proven to be efficacious in reducing intrahepatic lipid deposition and improving liver enzyme levels, while also having the potential to mitigate the progression of liver fibrosis. Altogether, this article reviews the association, mechanism and pharmacological treatment of MASLD and its associated liver fibrosis with T2DM and its cardiovascular complications, aiming to provide novel insights for the clinical diagnosis and treatment of patients with T2DM and MASLD.

代谢功能障碍相关脂肪性肝病（MASLD）与2型糖尿病（T2DM）存在密切关联。MASLD及其引起的肝纤维化一方面通过诱导胰岛素抵抗和直接影响肝糖原合成促进T2DM的发生、进展；另一方面，通过胰岛素抵抗引起的血管内皮因子异常、血脂异常及诱导高凝状态显著增加了T2DM患者心血管并发症的发生风险和死亡率。在药物治疗方面，一些多靶点的新型降糖药物不仅能够有效减少肝内脂质沉积，改善肝脏血清学指标，而且对于延缓肝纤维化进展也具有潜在价值。本文综述了MASLD及肝纤维化与T2DM及心血管并发症发生的相关性、机制和药物治疗方面的研究进展，以期为T2DM合并MASLD患者的临床诊疗提供新的思路。