However, the higher risk for several complications in SIRD clearly indicates the need for treatment intensification addressing CKD, CVD and NAFLD (e.g. by sodium–glucose cotransporter 2 inhibitors [SGLT2is] and glucagon-like peptide-1 receptor agonists [GLP-1RAs]), as well as targeting insulin resistance (e.g. by future insulin sensitisers) (Fig. 1). Here, INS is linked to metabolic dysfunction-associated steatotic liver disease.