Grant: Project Grant

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is caused by fat accumulating in the liver over time. Fat causes inflammation, which scares the liver (known as liver fibrosis) and puts patients at increased risk of many more severe liver conditions. It is estimated that 1 in 4 Canadians has MASLD, but very few are aware. Often, there are no symptoms until advanced liver disease has developed. This is why screening is critical. People with type 2 diabetes are at a high risk of advanced disease progression, making them an ideal population for screening. International experts recommend using a simple test called the Fibrosis-4 index (FIB-4) to screen for advanced liver fibrosis in high-risk groups like people with diabetes. However, there are currently no Canadian Diabetes guidelines for screening for fibrosis. And access to the necessary blood tests to calculate FIB-4 is not currently universally available. These barriers can lead to healthcare inequities, especially for underserved communities. We propose to describe the variability in screening strategies (different blood tests) and rates over time. We will then identify factors and subgroups of people with distinct screening patterns and examine how these patterns are associated with liver disease progression. Finally, we will evaluate which screening strategy is the most cost-effective. We will use data routinely collected from health records and advanced statistical methods to account for many of the biases found when using this type of data. Our team comprises various healthcare professionals, patient advocates, and partners to ensure our findings will inform Canadian diabetes guidelines and lead to better healthcare. Ultimately, the goal is to develop effective and equitable screening strategies to prevent liver disease progression in people with diabetes.