Current guidelines do not recommend screening for non‐alcoholic fatty liver disease (NAFLD) or advanced fibrosis. Patients with type 2 diabetes mellitus (T2DM) are known to be at increased risk for NAFLD and advanced fibrosis.

To assess the feasibility in diabetics in a primary care setting of screening for NAFLD and advanced fibrosis, by using non‐invasive magnetic resonance imaging (MRI) to estimate the hepatic proton density fat fraction (MRI‐PDFF) and magnetic resonance elastography (MRE) to estimate hepatic stiffness.

We performed a cross‐sectional analysis of a prospective study that included 100 (53% men) consecutively enrolled diabetics who did not have any other aetiology of liver disease. All patients underwent a standardised research visit, laboratory tests, MRI‐PDFF, and MRE.

Mean (±s.d.) age and body mass index (BMI) was 59.7 (±11.2) years and 30.8 (±6.5) kg/m², respectively. The prevalence of NAFLD (defined as MRI‐PDFF ≥5%) and advanced fibrosis (defined as MRE ≥3.6 kPa) was 65% and 7.1%, respectively. One patient with advanced fibrosis had definite hepatocellular carcinoma. When compared to those without NAFLD, patients with NAFLD were younger (P = 0.028) and had higher mean BMI (P = 0.0008), waist circumference (P < 0.0001) and prevalence of metabolic syndrome (84.6% vs. 40.0%, P < 0.0001). Only 26% of those with NAFLD had elevated alanine aminotransferase.

This proof‐of‐concept study demonstrates that T2DM has significant rates of both NAFLD and advanced fibrosis. Concomitant screening for NAFLD and advanced fibrosis by using MRI‐proton density fat fraction and magnetic resonance elastography in T2DM is feasible and may be considered after validation in a larger cohort.