Metabolic dysfunction-associated steatotic liver disease (MASLD) is common in adults with type 2 diabetes (T2D), in whom advanced fibrosis may be asymptomatic yet strongly associated with liver-related outcomes. Implementation of fibrosis detection, risk stratification, referral, and management varies across diabetes and hepatology services.

To map evidence and guidance on MASLD/MASH screening, fibrosis risk stratification, referral, integrated care, and post-identification management in adults with T2D.

Following JBI scoping review methodology and PRISMA-ScR guidance, five databases were searched in June 2026, with a final PubMed/MEDLINE update on 10 July 2026, supplemented by guideline bibliographies and manual society searches. Of 1,279 database records screened and 224 reports assessed at full text, 106 sources met eligibility criteria and were included in narrative synthesis. No formal risk-of-bias appraisal or quantitative pooling was undertaken.

Evidence converged on a fibrosis-focused, sequential non-invasive testing model, typically using FIB-4 for first-line triage followed by transient elastography or other second-line testing before specialist referral. Two-step pathways improved advanced-fibrosis identification and reduced unnecessary referral, with increasing integration into primary care and diabetes services. Key constraints were limited elastography access, clinician unfamiliarity, threshold uncertainty, and geographic concentration in high-income settings. Longitudinal outcome validation and economic evidence remained limited.

A coherent diabetes-centred MASLD screening and care model has emerged, but its evidence base remains dominated by diagnostic and implementation studies rather than demonstrated patient-outcome benefit. Priorities include T2D-specific calibration, access to confirmatory testing, longitudinal and economic validation, equitable implementation, and treatment-era pathway redesign.