{
  "abstract": "Introduction The 2024 EASL MASLD guideline recommends FIB4 screening for all people with type 2 diabetes [T2D], however universal primary care screening and timely hepatology referral for high-risk individuals is challenging. We integrated a reflexive MASLD fibrosis screening algorithm into iDiabetesPlus, a precision diabetes mellitus [DM] care platform. Here we present the key MASLD screening results from the first full year of the iDiabetesPlus trialMethods Following a pilot, iDiabetesPlus was implemented as new standard DM care from 01/01/25 in 16 primary care practices in NHS Tayside, Scotland. All patients with DM are automatically enrolled into iDiabetesPlus at their annual DM review.The iDiabetesPlus MASLD screening algorithm performs automated FIB4 screening for all patients. If ALT>30, reflex liver aetiological screening and NAFLD Fibrosis Score [NFS] calculation is performed, with reflexive Enhanced Liver Fibrosis [ELF] testing in indeterminate or high risk FIB4/NFS. Automated secondary care referral is generated for those with ELF ≥9.8, FIB4 >2.67, NFS >0.675 or positive aetiology results. For all enrolled patients, iDiabetesPlus generates personalised DM and MASLD management recommendations and guidance on timing of interval FIB4 testing.Results From 28/10/24-31/10/25, 5152 people with diabetes were enrolled in iDiabetesPlus. 5111 (99.2%) received FIB4 screening. 698 (13.99%) T2D patients generated an automated secondary care referral. See table 1 for full demographic and screening results.Conclusions The incorporation of automated MASLD screening into iDiabetesPlus has achieved universal FIB4 testing in a real-world primary care DM population. Targeted second-line ELF testing reduces the number requiring secondary care referral by >50% in those tested. Importantly, our screening algorithm has identified new MASLD with advanced fibrosis or cirrhosis in 2.3% of 4,693 prospectively screened people with T2D.Abstract FP30 Table 1Demographics and fibrosis assessment of iDiabetesPlus enrolled patientsAll(n=5152)T2(n=4693)T1(n=358)Age [years] (median, range)67 (18–98)68 (23-98)54 (18-90)Female (n (%))2157 (41.9%)1954 (41.6%)158 (44.1%)HbA1c [mmol/mol] (median (IQR))59 (21)58 (20)68 (23)BMI [kg/m2]Median (IQR)30.8 (8.1)31.0 (8.0)28.0 (7.7)≥30kg/m2 (n(%))2869 (55.7%)2701 (57.6%)122 (34.1%)ALT [iU](n=5146)Median (IQR)25 (16)25 (16)22 (11)>30 (n(%))1643 (31.9%)1524 (32.5%)81 (22.9%)FIB4**(n=5111)Low risk4306 (84.2%)3912 (83.9%)311 (89.1%)Intermediate risk615 (12.0%)569 (12.2%)34 (9.7%High risk190 (3.7%)181 (3.9%)4 (1.1%)ELF**(n=1105)<9.8591 (53.5%)575 (53.5%)10 (58.8%)≥9.8514 (46.5%)500 (46.5%)7 (41.2%)Fibroscan LSM** [kPa](n=477)<8.0252 (52.8%)245 (52.4%)7 (77.8%)8.0-12.0118 (24.7%)117 (25.0%)1 (11.1%)>12.0107 (22.4%)106 (22.6%)1 (11.1%)*FIB4 - Low risk: <1.3 aged <65, <2.0 aged 65+; Intermediate risk: 1.3-2.67 aged <65, 2.0-2.67 aged 65+; High risk: >2.67; percentage shown are of number of FIB4 performed in each group**Percentages shown are of total number of tests performed in each subgroup",
  "authors": [
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Damien Leith"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Rachael Barrett"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "YeunYi Lin"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Mya Win"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Paul N Brennan"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Ruairi Lynch"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Evelyn Anyebe"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "Ewan Pearson"
    },
    {
      "affiliations": [
        "Ninewells Hospital and Medical School, Dundee, United Kingdom"
      ],
      "name": "John F Dillon"
    }
  ],
  "title": "FP30 Universal FIB4 screening, automated secondary care referral, new cirrhosis diagnosis - intelligent MASLD detection within the iDiabetesPlus precision care platform",
  "uid": "b989c06a-7f0b-53e1-9077-7719a6d646f3"
}