TouchENDOCRINOLOGY coverage from EASD 2025:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in people with type 2 diabetes (T2D) and is increasingly recognized as an important contributor to cardiovascular morbidity and mortality. Early detection of hepatic fibrosis is therefore critical, not only for identifying liver-related complications but also for guiding broader cardiovascular risk management in this high-risk population.
At the EASD 2025 congress (Vienna, Austria; 15–19 September), Dr Thinzar Min (Swansea University, UK) presented new data exploring the relationship between non-invasive measures of hepatic fibrosis and predicted cardiovascular risk in individuals with T2D. Her analysis highlighted the potential clinical utility of the Enhanced Liver Fibrosis (ELF) test, which demonstrated a significant correlation with QRISK-3 cardiovascular risk scores. These findings suggest a possible dual role for the ELF test: identifying advanced fibrosis and stratifying cardiovascular risk, which could support more targeted management strategies in routine diabetes care.
In this interview, Dr Min discusses the rationale behind the study, its design and key findings, and the implications for future clinical practice and research.
Q. What is the Enhanced Liver Fibrosis test, and what is known about its role in the pathogenesis and assessment of metabolic dysfunction-associated steatotic liver disease and cardiovascular risk in people with type 2 diabetes?
The ELF test is a non-invasive biomarker used to detect liver fibrosis. It is currently recommended as a second-line test in most national and international guidelines for screening people with MASLD. However, its potential role in assessing cardiovascular risk, particularly in people with T2D, is not yet well established. That was one of the key reasons for our study: while we already know the ELF test performs well in detecting advanced fibrosis and cirrhosis, we wanted to explore whether it may also have an additional role in identifying cardiovascular risk in this high-risk population.
Q. Could you describe the aims, design, and patient population of your study investigating the correlation between non-invasive measures of hepatic fibrosis and predicted cardiovascular risk in individuals with type 2 diabetes?
We conducted a cross-sectional, prospective study in our secondary care diabetes clinic. The primary aim was to identify the burden of MASLD and, in particular, advanced fibrosis in people with T2D attending hospital clinics.
The project I presented at EASD was a secondary analysis of that larger study. We recruited 200 individuals with T2D in Swansea, irrespective of their diabetes treatment, but excluded those with known liver disease or a history of excess alcohol consumption. Each participant underwent a panel of non-invasive tests, including commonly used fibrosis markers such as the FIB-4 score, AST:ALT ratio, the NAFLD fibrosis score, and the ELF test.
Since the ELF test is not yet routinely available in the NHS, one of our objectives was to evaluate its utility in diabetes clinics. In addition, all participants had FibroScan to compare blood-based non-invasive markers with imaging-based assessments. We then explored which of these measures correlated best with predicted cardiovascular risk.
Q. What were the key findings of your analysis, particularly regarding the performance of the ELF test compared with other non-invasive fibrosis markers and FibroScan-based measures?
One interesting observation was the discrepancy between the different non-invasive tests. For example, using FIB-4, around 22% of participants were classified as being at risk of advanced fibrosis, whereas with the ELF test, this proportion was closer to 45%. This highlights that the tests may identify different subsets of patients.
At this stage, we cannot determine which test is more sensitive or specific because the liver biopsy has not yet been performed in this cohort. All patients identified as high risk were referred to hepatology, and we are awaiting biopsy outcomes to confirm the accuracy of each test.
Q. How might these findings influence clinical practice, particularly the integration of liver fibrosis assessment into routine cardiovascular risk management for people with type 2 diabetes?
Our data showed that the ELF test correlated well with predicted cardiovascular risk scores. This suggests that patients with higher ELF scores may not only have a greater risk of advanced liver fibrosis but also an elevated cardiovascular risk.
Although further validation is needed, these findings raise the possibility that the ELF test could serve a dual purpose: detecting liver disease and identifying patients at higher cardiovascular risk. This could support earlier intervention and more targeted management strategies in people with T2D.
Q. What further research is needed to validate these findings, and what do you see as the next steps toward implementing the ELF test more broadly in diabetes care pathways?
Our study included only 200 patients, mainly from secondary care clinics where comorbidities are more common. Larger studies, particularly in primary care populations, are needed to confirm and extend our findings.
While MASLD has been a “hot topic” in diabetes over the past few years, routine liver screening is still limited in practice. One barrier is uncertainty among clinicians about how to manage patients once liver disease is identified. However, with new treatments for advanced fibrosis emerging, early detection will become increasingly important.
There are also practical and financial considerations. FibroScan requires specialized equipment and trained staff, costing around £60 per scan. By contrast, the ELF test is a simple blood test costing a similar amount but without the logistical challenges. This makes it a potentially more feasible option for routine use in diabetes clinics.
Overall, while challenges remain, these results support further evaluation of the ELF test as a practical tool for both liver and cardiovascular risk assessment in people with T2D.
About Dr Thinzar Min
Dr Thinzar Min is a Senior Clinical Lecturer and Consultant Physician in Diabetes and Endocrinology at Swansea Bay University Health Board and Swansea University Medical School. She completed her specialist training in Wales and holds an MSc in Diabetes with distinction, as well as an MD in Diabetes and Obesity. Her research focuses on metabolic outcomes in diabetes, and she is actively involved in clinical care, teaching and hospital leadership roles.
This content has been developed independently by Touch Medical Media for touchENDOCRINOLOGY. It is not affiliated with the European Association for the Study of Diabetes (EASD). Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
Abstract:Min T, Nagaraj J, Stephens JW, Williams D. A new horizon in risk assessment: ELF test and cardiovascular health in type 2 diabetes. Abstract #596. Presented at: EASD 2025, Vienna, Austria, 15–19 September.
