SUN-625 - Benefits of Structured Provider Education to Improve MASLD Risk Screening in Type 2 Diabetes Patients: A Quality Improvement Project

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common cause of chronic liver disease and one of the leading indications for liver transplantation in the USA. It affects 30-40% of adults, and its prevalence increases to 60-70% for people with type 2 diabetes (pwT2D). FIB-4 is an excellent screening test for identifying at-risk patients, due to its wide availability utilizing variables commonly available for routine blood testing. However, it is not well understood whether endocrinologists are comfortable using FIB-4 as a screening tool, nor what are the barriers in the implementation of FIB-4 to screen pwT2D at risk for MASLD with clinically significant fibrosis.

Methods: A qualitive improvement project was designed to assess MASLD screening in pwT2D at an academic endocrinology practice and to determine if increased awareness provided via structured education and educational materials would increase provider awareness and screening for MASLD with FIB-4. Following online anonymous consent, a pre-intervention survey invitation via RedCap was emailed to 18 endocrinology providers. The 9-question survey assessed the providers’ comfort level in fibrosis screening for MASLD in pwT2D, as well as general knowledge about MASLD prevalence in the population. The survey distribution was followed by a structured 30-minute education session and the distribution of a 1-page educational brochure on MASLD and fibrosis screening in pwT2D. The same 9-question survey was sent to the same endocrinology providers after 90 days.

Results: 15/18 providers answered the pre-intervention survey, while 10/15 providers answered the post-intervention survey. There was a 78.9% increase in the frequency of MASLD screening from baseline, with a shift from “very rarely” (46.7%) and “rarely” (33.3%) to “sometimes” (30%), “frequently” (30%) and “very frequently” (20%). When asked about the comfort level with 2025 American Diabetes Association guidelines for MASLD screening in pwT2D, a 56% increase was seen (2.5 “pre” to 3.9 “post” average score). A 95% increase was seen in providers’ comfort level in making management decision for pwT2D based on FIB-4 score (from 2.1 “pre” to 3.9 “post” average score), while an 87% increase was seen for the question on comfort in understanding when to order a Fibroscan for MASLD in pwT2D (“pre” 2.3 to 4.3 “post” average score). Furthermore, a shift to using FIB-4 as the initial screening test for pwT2D was seen in the post intervention survey (73%-100% “pre” vs. “post”).

Conclusions: Structured education and educational materials are beneficial in increasing awareness of the need for MASLD and fibrosis screening in pwT2D, increasing comfort in making management decisions for pwT2D based on FIB-4 scores, and increasing the use of FIB-4 as screening tool for identifying at-risk MASLD in pwT2D at an academic endocrinology practice.

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