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18; 95%CI 1.07-1.3. Among 2,179 subjects in the validation cohort, the prevalence of MAFLD was 67.8% and was greater in those with high HSI. Performance of HSI for ultrasound-detected MAFLD was moderate (AUROC 0.7, yet steatosis prevalence was threefold higher among subjects with HSI 36 than among those with HSI 30. Notably, HSI declined significantly ~ 6months after initiation of dapagliflozin or incretin-based therapies, but not gliclazide. About three quarters of patients with T2D have HSI values suggestive of MAF