Diabetes may be silently damaging your liver: Study of 9,000 Indians finds alarming link

Most people with diabetes worry about their heart, kidneys, or eyes. But a large new Indian study suggests the liver may be quietly at risk too—and many don’t even know it.

A 2026 multicentre study, named DiaFib-Liver Study, found a connection in an often-overlooked complication of Type 2 Diabetes and liver damage. Specifically, it examines how common liver fibrosis (scarring of the liver) is among people living with diabetes, and why this matters more than previously understood. The study focuses on a condition called Metabolic dysfunction-associated steatotic liver disease—a newer term that replaces what was previously known as fatty liver disease. MASLD occurs when excess fat builds up in the liver due to metabolic problems like obesity and insulin resistance.
"One in four adults with T2D in India has clinically significant liver fibrosis and one in twenty already has probable cirrhosis based on elastography thresholds, establishing advanced liver disease as a “fourth major complication” of diabetes," the researchers found challenging the widely discussed nature of diabetes complications that happens at microvascular level such as retinopathy, nephropathy, and neuropathy. Fibrosis—not steatosis, should be the focus of systematic assessment in diabetes care, they recommend.
Researchers emphasize that MASLD is not rare, it is extremely common in people with type 2 diabetes. Over time, this fat accumulation can trigger inflammation and lead to fibrosis, where healthy liver tissue is gradually replaced by scar tissue.
TOI Health connected with Dr. Kapil Sharma,Group Director - Gastroenterology, Yatharth Super Speciality Hospital Faridabad Sector 20 to discuss the link between diabetes and liver disease.

Dr. Kapil Sharma: Insulin resistant diabetes affects both liver health and diabetes because of how much fat and glucose is stored in the body when suffering from Type 2 Diabetes. Fat also gets collected within the liver, which can lead to the eventual onset of fatty liver disease. According to statistics, up to 70 per cent of all diabetics have fat stored in their livers, and it turns into inflammation and fibrosis over time due to multiple pathways such as the chronic inflammatory response from the body, i.e inflammation or inflammatory cytokines and abnormal lipid metabolism.

Dr. Kapil Sharma: Patients with diabetes need to control their weight, eat a balanced diet, and do regular exercise to help reduce the amount of fat stored within their livers, particularly they should reduce their consumption of refined carbohydrates and alcohol in addition, they need to maintain blood sugar levels as low as possible to help decrease the risk of damage from the liver. Regular screening tests, such as liver enzyme testing and FibroScan , should be performed so that any Liver dysfunction can be detected early to help prevent complications associated with future damage to the liver. Managing cholesterol and blood pressure will also help prevent the development of Cirrhosis or Fibrosis from Diabetes related to excessive fat trapping.

Dr. Kapil Sharma: Obesity, poor glucose control, hypertriglyceridemia and metabolic syndrome are all key risk factors, as are increased waist circumference and increased hepatic enzymes, both of which increase the risk for diabetes-associated progression from fatty liver to fibrosis and the fact that individuals with diabetes demonstrate higher rates of advanced fibrosis compared with those without diabetes even when their liver tests are normal: silent progression poses an even greater threat.

Dr. Kapil Sharma: Steatosis is the cumulative accumulation of fat in your liver and is for the most part, reversible and won’t have any immediate complication as long as it is detected early on. In contrast, fibrosis refers to the creation of scar tissue in your liver as a result of ongoing tissue damage and ongoing inflammation. Unlike fat accumulation, fibrosis indicates that the disease is worse or progressing towards becoming more severe and is therefore strongly associated with serious and potentially life-threatening complications, such as cirrhosis, liver failure, and increased risk of death. Accordingly, it is why the consensus amongst experts is such that there should be greater emphasis placed on screening and detection of fibrosis, rather than just steatosis, as fibrosis is a better marker of disease severity and to help identify outcomes or potential long-term complications.

The concern is that liver damage can stay silent for years. By the time symptoms show up, the disease may already be advanced. For people with diabetes, looking beyond blood sugar and paying attention to liver health could make a real difference.