The proposal led by Javier Crespo from IDIVAL and Valdecilla will demonstrate a coordinated screening model for metabolic liver disease in patients with type 2 diabetes, scalable to other healthcare systems
The proposal El Modelo Cantabria (The Cantabria Model), submitted by researchers from the Valdecilla Research Institute (IDIVAL) and the Marqués de Valdecilla University Hospital (HUMV), has been selected as one of only two projects worldwide in the Win‑Win Challenge 2026, the international initiative promoted by Boehringer Ingelheim and Echosens to develop and implement innovative solutions to address the underdiagnosis of metabolic liver disease.
From among the numerous applications submitted by research teams across the globe, the jury from both companies selected only two projects: the Spanish one, led by Javier Crespo, and another from Canada. The organization highlighted the extraordinary scientific and innovative level of the proposals evaluated, particularly recognizing the methodological rigor and transferability potential of the Cantabria Model.
The project is co‑led by Javier Crespo, Paula Iruzubieta and Joaquín Cabezas, researchers at IDIVAL and the Digestive System Department at Valdecilla, within the framework of the Cohorte Cantabria.
A systemic, not clinical, problem
Up to 70% of people with type 2 diabetes mellitus (T2DM) have metabolic dysfunction‑associated steatotic liver disease (MASLD), and around 15% develop significant liver fibrosis, the main driver of progression to advanced disease. Although the 2024 EASL‑EASD‑EASO clinical guidelines recommend fibrosis screening in this population, in routine practice the care pathway remains fragmented and hospital‑dependent: manual calculation of the FIB‑4 index, successive referrals, waiting lists, and patient loss at every step, with diagnostic times exceeding twelve months.
The bottleneck is not clinical—it is systemic, the proposal summarizes. In response, the Cantabria Model, built upon the Cohorte Cantabria, proposes a solution that makes screening a property of the system rather than a clinician‑dependent decision.
The core of the project: diagnosis in a single step and a single visit
Its distinctive feature is resolving in a single clinical encounter not only the diagnosis of hepatic steatosis and fibrosis, but also the full spectrum of associated metabolic and cardiovascular comorbidities. The FIB‑4 index is automatically calculated in the laboratory, so screening no longer depends on the clinician’s decision but becomes a systematic and traceable property of the system.
Patients with an elevated FIB‑4 are scheduled for a single visit, where a comprehensive hepato‑metabolic assessment is completed: evaluation of hepatic fibrosis and steatosis, body composition analysis, extended blood tests, and cardiovascular risk estimation. One visit, a complete characterization of the patient.
The design also incorporates a rigorous territorial equity analysis using multilevel models by Basic Health Zone, ensuring that automated detection reaches the entire target population equally.
A result exportable to any healthcare system
The project to be carried out within the Cohorte Cantabria is not intended to be just another pilot, but to deliver an exportable care model: a solution that can be replicated in any health system with a centralized laboratory and a public primary care network.
This international recognition reflects our confidence that integrating metabolic liver disease screening into the infrastructure of the healthcare system is possible. The Cantabria Model will demonstrate that liver fibrosis detection can be systematic, traceable, and equitable, without requiring anything extraordinary from clinicians or patients, and offers a solution that can be exported to other health systems.
About the Win‑Win Challenge
The Win‑Win Challenge was created within the collaboration between Boehringer Ingelheim and Echosens with the aim of addressing the underdiagnosis of metabolic liver disease and contributing to a more efficient and equitable care model.
