The Japan Society of Hepatology issued the "Nara Declaration 2023," which establishes an alanine aminotransferase (ALT) threshold of > 30 U/L for the early detection and management of liver diseases. Given the high prevalence of fatty liver disease among diabetic patients, this study aimed to assess the proportion of individuals with type 2 diabetes who met the criteria outlined in the "Nara Declaration 2023." A total of 4,021 patients with type 2 diabetes whose ALT levels were measured at our clinic throughout 2023 were included in the analysis. Of these, 965 (24.0 %) had ALT levels > 30 U/L. In this group, 614 patients (15.3 %) met the criteria for referral to a gastroenterologist, which was defined as platelet count < 200,000/μL or FIB-4 index ≥ 1.3. The demographic characteristics of the patients recommended for referral indicated a higher prevalence of males and older individuals.