Background: The strong association between type 2 diabetes mellitus (T2DM) and fatty liver is well known, and its nomenclature has even recently changed to metabolic dysfunction-associated steatotic liver disease (MASLD). Healthy MASLD patients are frequently overlooked and maltreated, especially in Bangladesh. In this present study, we tried to correlate T2DM burden in apparently healthy, incidentally diagnosed fatty liver patients on ultrasound. Materials and methods: This cross-sectional study was done in Sheikh Hasina Medical College Hospital, Tangail, Bangladesh, from August 2022 to February 2023. A total of 92 patients with ultrasonological evidence of grade II fatty change in the liver were included and evaluated. Known T2DM, hypothyroidism, consumption of alcohol, HBV or HCV infection, Wilson’s disease, autoimmune liver disease, hemochromatosis, and any other chronic liver or kidney disease patients were excluded. The patients were then assessed for the presence and absence of T2DM using OGTT (2 hours 75 gm glucose ≥ 11.1 mmol/L) and/or HbA1c (≥6.5%) as diagnostic criteria. Data was analyzed by SPSS, version 23. Results: Out of 92 patients, 48 were male and 44 were female. A total of 50 patients (54.3%) were newly diagnosed with T2DM. Statistically significant differences were seen in the T2DM group and non-DM group for AST (50.33 IU vs 36.53 IU) and TG (270 mg/dL vs 189 mg/dL). Although no noteworthy differences were evident in mean age (41 years vs 38 years), ALT (58.9 IU vs 60.23 IU), and BMI (28.85 vs 29.29). Conclusions: In the present study, more than 54% of patients with grade II fatty liver were newly diagnosed with T2DM. They would later present with more advanced T2DM and related complications. Although a larger study is needed, physicians and healthcare workers in Bangladesh should be more concerned about treating MASLD patients with early diagnosis of T2DM, recommending prompt lifestyle interventions, and prescribing drugs if necessary.