Metabolic dysfunction-associated steatotic liver disease (MASLD) and type 2 diabetes mellitus (T2DM) frequently coexist and mutually reinforce one another through shared pathological mechanisms, including insulin resistance, disruptions in lipid homeostasis, and chronic low-grade inflammation. MASLD is now recognized as a major comorbid condition in individuals with T2DM and is associated with substantially increased risks of cardiovascular events, progression of hepatic fibrosis, and all-cause mortality. In 2025, the American Diabetes Association (ADA) released a consensus report that, for the first time, incorporates MASLD into the standardized management framework for T2DM. The report provides recommendations for screening, risk stratification, and therapeutic intervention, and highlights the potential hepatoprotective effects of glucose-lowering agents on steatosis, inflammation, and fibrosis. This review summarizes the bidirectional pathophysiological interplay between MASLD and T2DM, synthesizes clinical and translational evidence regarding the hepatic benefits of major antidiabetic drug classes-including incretin-based therapies, sodium-glucose cotransporter-2 inhibitors, and peroxisome proliferator-activated receptor agonists-and proposes individualized management strategies that span lifestyle modification and pharmacologic therapy, guided by fibrosis stage and metabolic comorbidities in alignment with ADA recommendations. The importance of multidisciplinary collaboration in the comprehensive management of patients with T2DM and MASLD is also emphasized.

代谢功能障碍相关脂肪性肝病（MASLD）与2型糖尿病（T2DM）高度共存，两者在胰岛素抵抗、脂质稳态紊乱及慢性炎症等病理过程中相互促进。MASLD已被视为T2DM的重要共病基础，其显著增加了心血管事件、肝纤维化进展及全因死亡风险。2025年美国糖尿病学会（ADA）发布的MASLD共识报告Metabolic Dysfunction-Associated Steatotic Liver Disease in People with Diabetes: the Need for Screening and Early Intervention首次将MASLD纳入T2DM的系统管理框架，提出规范化的筛查、风险分层与干预建议，并强调降糖药物在改善肝脏脂肪沉积、炎症及纤维化方面的潜在治疗价值。本文综述了T2DM与MASLD的代谢交互作用机制，系统总结了主要降糖药物（包括肠促胰素类、钠-葡萄糖协同转运蛋白2抑制剂、过氧化物酶体增殖激活受体激动剂等）改善MASLD的临床与转化医学证据；并基于肝纤维化程度及代谢共病，结合ADA共识提出从生活方式干预到药物选择的个体化管理策略，同时强调跨学科协作在T2DM-MASLD综合管理中的关键作用。