Increased risk of cirrhosis and its decompensation in chronic hepatitis C patients with new-onset diabetes: A nationwide cohort study

Abstract

The effect of diabetes on cirrhosis, its decompensation, and their time relationship in chronic hepatitis C (CHC) patients remains unclear. We conducted a nation-wide cohort study by using the Taiwanese National Health Insurance Research Database, which is comprised of data from >99% of the entire population. Among having randomly sampled 1 million enrollees, 6,251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in CHC patients who were given the diagnosis in the years 1999-2003, but not in 1997-1998. The cohorts of CHC with new-onset diabetes (n 5 424) and nondiabetes (n 5 1,708) were followed up from inception point in diabetes and from year 1999 in the nondiabetes cohort until development of cirrhosis or its decompensation, withdrawal from insurance, or December 2009. Kaplan-Meier's survival analysis showed a significantly higher cumulative incidence of cirrhosis (relative risk [RR] 5 1.53; 95% confidence interval [CI] 5 1.11-2.11; log-rank test; P < 0.001) and decompensated cirrhosis (RR 5 2.01; 95% CI 5 1.07-3.79; log-rank test; P < 0.001) among patients with new-onset diabetes, as compared to those without. After adjustment for age, gender, CHC treatment, diabetes treatment, hepatocellular carcinoma, comorbidity index, hypertension, hyperlipidemia, and obesity by Cox's proportional hazard model, diabetes was still an independent predictor for cirrhosis (hazard ratio [HR] 5 2.505; 95% CI 5 1.609-3.897; P < 0.001) and its decompensation (HR 5 3.560; 95% CI 5 1.526-8.307; P 5 0.003). Conclusion: CHC patients who develop diabetes are at an increased risk of liver cirrhosis and its decompensation over time. (HEPATOLOGY 2014;60:807-814)

Concurrent Obesity, Diabetes, and Steatosis Increase Risk of Advanced Fibrosis Among HCV Patients: A Systematic Review

“…In a recent large population-based study in Taiwan, Huang et al evaluated liver-related outcomes among 424 chronic HCV patients with DM and 1708 chronic HCV patients without DM. While concurrent DM was associated with significantly greater risk of developing cirrhosis, there was no significant association with obesity and cirrhosis (HR 0.97; 95 % CI 0.24-3.96; p = 0.965) [9].…”

“…In particular, the effects of diabetes mellitus (DM), metabolic syndrome, and concurrent nonalcoholic fatty liver disease (NAFLD) have been implicated in the progression of hepatic fibrosis and cirrhosis [2]. However, the impact of the aforementioned factors on progression of disease among chronic HCV patients is complicated by conflicting results of existing studies [3,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Furthermore, the lack of consistency in defining certain risk factors (e.g., obesity, DM, insulin resistance) among published studies additionally complicates the ability to truly ascertain the impact of these comorbidities on HCV progression.…”

The Metabolic Syndrome Is Not Correlated with the Short-term Risk of Decompensation in Patients with Cirrhosis

“…Diabetes only in uenced transplantation-free survival in patients with a MELD score less than 10. New onset diabetes in patients with chronic hepatitis C proved to increase the risk of cirrhosis development and decompensation [19]. However, in this retrospective study, patients with new onset diabetes at inclusion were signi cantly older, with more advanced liver disease and with more co-morbidities resulting in a possible selection bias.…”

Promoting a Healthy Lifestyle, Managing Hyperlipidemia, Diabetes Mellitus, Hypertension, and Immunizations in Patients with Cirrhosis

“…Patients with preexisting DM should be distinguished from cirrhotic patients who develop DM, sometimes referred to as hepatogenous diabetes [40]. Hepatogenous diabetes is associated with a lower risk of macro-and microvascular complications than classical type 2 DM, but both are associated with an increased risk of liver complications including higher rates of liver decompensation and HCC [38,[41][42][43]. Good glycemic control (a glycosylated hemoglobin less than 7.0 %) has been associated with improved liver outcomes.…”