Steroid-induced diabetes (CD) is a iatrogenic disease that occurs after administration of glucocorticoids (GCs) in patients without previous documented hyperglycemia; the risk is more than double in elderly patients. The mechanisms responsible for CD include reduced insulin sensitivity and the compromised compensatory increase in insulin secretion. Non-Alcoholic Fatty Liver Disease (NAFLD) is a liver disease associated with overnutrition and cardiometabolic risk factors, particularly obesity and type 2 diabetes (T2D), in the absence of excessive alcohol consumption or chronic liver diseases. NAFLD is caused by lipids accumulation in the hepatocytes, macrophage infiltration and a proinflammatory state that promotes insulin resistance. Abdominal ultrasonography is the faster non invasive method to detect hepatic steatosis. There is a strong correlation between T2D and NAFLD (40-70% prevalence) and patients with T2D are more likely to develop advanced fibrosis, cirrhosis, and hepatocellular carcinoma. However, there is small data linking the presence of steatosis and the onset of CD, even if steroid therapy is widely prescribed in medical wards. The aim of our study is to identify and staging hepatic steatosis as a predictive factor for the onset of CD in hospitalized patients. Materials and methods: This is preliminary observational study involving elderly patients afferent to the Post-acute care department of Delmati Hospital (ASST Lodi) treated with GCs. We collected clinical and biochemical data (absence of known hepatic disease, HbA1c, glycemia, kidney function), information about steroid therapy (type, dosage, duration). The presence and degree of steatosis was evaluated by bedside abdominal ultrasonography. Results and conclusions: We started in March 2024, currently we enrolled 4 patients. The average age is 80.7; 2 patients develop CD. Prevalence of hepatic steatosis was 50% in patients with CD and 0% in patients without CD. The aim of our work is to explore NAFLD as risk factor for developing CD; early identification of high-risk patients could justify a more intensive screening and surveillance in order to prevent diabetic complications.