Background: The coexistence of type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) accelerates the progression of cardiovascular and metabolic disorders. To mitigate the medical and economic burden associated with these comorbidities, identifying their risk factors is essential. Aim: to assess the prevalence of MASLD and identify its associated risk factors in T2D patients in Tunisia. Methods: This descriptive and analytical study included 202 T2D patients followed over a 12-year period at the Endocrinology Department in Sfax, Tunisia. Patients were divided into two groups: 101 patients with confirmed MASLD (G1) and 101 patients without MASLD (G2). Results: The prevalence of MASLD was 17.03%. A family history of autoimmunity was significantly associated with MASLD. Glycemic control indicators, including HbA1C levels (p=0.943) and blood glucose levels (p=0.627), did not differ between groups. Insulin therapy was significantly less common in G1 (p=0.027). Abdominal obesity and elevated triglyceride levels were strongly associated with MASLD. Additionally, carbohydrate intake was higher in G1 compared to G2 (p=0.041). Multivariate analysis identified non-HDL cholesterol as the most significant independent risk factor for MASLD (odds ratio [OR]: 4.07 × 10⁵), followed by uric acid levels (OR: 1.03, p=0.024) in a 95% confidence interval of [1.004–1.058]. Conclusion: The findings reveal a notable prevalence of MASLD among T2D patients in Tunisia, with non-HDL cholesterol, uric acid levels, abdominal obesity, and dietary patterns emerging as key contributors. These results emphasize the need for targeted screening and management strategies of MASLD.