fig1

Figure 1. The performance gap of FIB-4 as a first-line tool in guidelines-recommended screening approach in patients with T2DM in a community setting. Schematic representation of the current sequential screening pathway for liver fibrosis in at risk populations. Due to the high prevalence of liver fibrosis in patients with T2DM, the NPV and Se are low, compared to those observed in patient populations with a lower prevalence of liver fibrosis. Consequently, a substantial proportion of patients with clinically significant liver fibrosis (VCTE ≥ 8.0; aligning with ≥ F2 fibrosis) fall below the 1.30 threshold, leading to false reassurance and missed opportunities for diagnosis and intervention. Created in BioRender. Bilson, J. (2026) https://BioRender.com/rfa80yb. ALT: Alanine transaminase; AST: aspartate transaminase; FIB-4: Fibrosis-4 index; MASLD: metabolic dysfunction-associated steatotic liver disease; NPV: negative predictive value; Se: sensitivity; T2DM: type 2 diabetes mellitus; VCTE: vibration-controlled transient elastography.