INS and hyperinsulinism: In this study, 3-year SGLT2i treatment did not improve HSI and APRI in insulin-treated patients; however, SGLT2is significantly reduced both HSI and APRI in insulin-naïve patients, suggesting that exogeneous insulin as well as endogenous hyperinsulinemia may adversely affect MASDL and may attenuate the beneficial effects of SGLT2is for MASLD.