Answer 1 is incorrect. 14.93% chose this answer. “Vitamin E and SGLT-2.”  While SGLT-2’s will help lower glucose levels and may result in some weight loss, the ADA does not recognize it as a treatment for steatosis. As far as Vitamin E, according to the ADA 2025 Standards, “it may be beneficial for the treatment of MASH in people without diabetes. However, in people with type 2 diabetes, vitamin E monotherapy was found to be ineffective in a small RCT, and it did not seem to enhance pioglitazone’s efficacy when used in combination, as reported in an earlier trial in this population.

Answer 2 is correct. 63.81% of you chose this answer. “Pioglitazone and/or GLP-1 RA / GIP.”  GREAT JOB, this is the best answer. According to the ADA Standards In adults with type 2 diabetes with biopsy-proven MASH or those at high risk for liver fibrosis (based on noninvasive tests), pioglitazone, a GLP-1 RA, or a dual GIP and GLP-1 RA is preferred for glycemic management because of potential beneficial effects on MASH.

Answer 3 is incorrect. About 12.69% of respondents chose this. “Fish oil supplements and statin.”  Part of this answer is correct.  Based on the 2025 ADA Standards, “Statin therapy is safe in adults with type 2 diabetes and compensated cirrhosis from MASLD and should be initiated or continued for cardiovascular risk reduction as clinically indicated. In people with decompensated cirrhosis, statin therapy should be used with caution, and close monitoring is needed, given limited safety and efficacy data.  However, the ADA does not recommend fish oil supplements to treat MASH.

Finally, Answer 4 is incorrect. 8.58% chose this answer. “Metformin and/or bolus insulin therapy.”  Although metformin therapy and insulin are effective at addressing insulin resistance and lower glucose levels, they are not first line recommended agents to treat MASH.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!