The impact of diabetes mellitus in mortality of patients with compensated liver cirrhosis-a prospective study

Quintana, Joel Omar Jáquez; García-Compeán, Diego; Gonzalez, Jose A.; Pérez, Jesús Zacarías Villarreal; González, Fernando Javier Lavalle; Espinosa, Linda Elsa Muñoz; Hernández, Pedro López; Cabello, Erick Reyes; Villarreal, Edgar Redondo; Rendon, Ricardo Flores; Garza, Héctor J. Maldonado

doi:10.1016/s1665-2681(19)31588-1

Cited by 53 publications

(8 citation statements)

References 36 publications

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“…[4,5] Patients with type 2 diabetes have an increased risk of developing NAFLD and associated complications, including liver cirrhosis and HCC. [5][6][7] In addition, mortality from chronic liver disease is more common among patients with type 2 diabetes and has, in contrast to mortality from cardiovascular and renal diseases, increased during the last decades. [8,9] Currently, there are no approved pharmacological interventions for preventing the onset and slowing progression of NAFLD.…”

Section: Introductionmentioning

confidence: 99%

Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study

Engström,

Wintzell,

Melbye

et al. 2023

Hepatology

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Background and Aims: Clinical trials suggest that glucagon-like peptide-1 (GLP-1) receptor agonists may have beneficial effects on NAFLD but the impact on hard hepatic endpoints is unknown. We assessed the association between use of GLP-1 receptor agonists and risk of serious liver events in routine clinical practice. Approach and Results: Cohort study using data from nationwide registers in Sweden, Denmark and Norway, 2007-2020, including 91 479 initiators of GLP-1 receptor agonists and 244 004 initiators of the active comparator, dipeptidyl peptidase-4 (DPP4) inhibitors, without a history of chronic liver disease other than NAFLD/NASH. The primary outcome was serious liver events: a composite of incident compensated and decompensated cirrhosis and hepatocellular carcinoma. Secondary outcomes were the individual components of the primary outcome. Cox regression was used to estimate hazard ratios (HRs), using propensity score weighting to control for confounding. Users of GLP-1 receptor agonists had 608 serious liver events (adjusted incidence rate 16.9 events per 10 000 person-years), compared with 1770 events among users of DPP4 inhibitors (19.2 events per 10 000 person-years). The adjusted HR was 0.85 (95% CI 0.75 to 0.97) and the rate difference was -2.1 (-4.4 to 0.1) events per 10 000 person-years. In secondary outcome analyses the adjusted HR was 0.85 (0.75 to 0.97) for compensated and decompensated cirrhosis and 1.05 (0.80 to 1.39) for hepatocellular carcinoma. Conclusions: Use of GLP-1 receptor agonists was associated with a significantly reduced risk of serious liver events, driven by a reduction of compensated and decompensated cirrhosis.

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Section: Introductionmentioning

confidence: 99%

Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study

Engström,

Wintzell,

Melbye

et al. 2023

Hepatology

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“…7 In addition, two prospective comparative studies reported that the 2.5-and 5-year cumulative survival was significantly lower in diabetic patients (48% and 49%) than in those without diabetes (69% and 100%, respectively). 8,9 While the above-mentioned studies have focused on the relationship between overt DM and survival in cirrhosis, the present study evaluated the prognostic value of glucose intolerance in the setting of IGT and subclinical DM by OGTT. One prospective study with 56 patients who had no history of T2DM demonstrated that DM was a significant prognostic factor with Child-Pugh scores.…”

Section: Discussionmentioning

confidence: 99%

“…The first cohort study reported the prognostic significance of diabetes in the long‐term follow‐up of patients with liver cirrhosis, with most deaths being mainly caused by an increased risk of liver failure 7 . In addition, two prospective comparative studies reported that the 2.5‐ and 5‐year cumulative survival was significantly lower in diabetic patients (48% and 49%) than in those without diabetes (69% and 100%, respectively) 8,9 …”

Section: Discussionmentioning

confidence: 99%

Subclinical diabetes confirmed by 75‐g OGTT influence on the prognosis of decompensated cirrhosis

Kang,

Kim,

Han

et al. 2023

J of Gastro and Hepatol

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Background and aimDisorders of glucose metabolism, such as impaired glucose tolerance (IGT) and diabetes mellitus (DM), frequently occur in cirrhosis. We aimed to evaluate who needs to be undertaken a 75‐g oral glucose tolerance test (OGTT) to find underlying subclinical diabetes.MethodsThis prospective study included 713 patients with either compensated (Child–Turcotte–Pugh [CTP] class A) or decompensated cirrhosis (CTP class B/C) without previous DM history. All patients underwent a 75‐g OGTT. The patients were divided into three groups: normal glucose tolerance (NGT), IGT, and newly diagnosed DM (subclinical DM).ResultsAmong 713 patients, NGT was diagnosed in 139 (19.5%), IGT in 252 (35.3%), and subclinical DM in 322 (45.2%) patients, respectively. During a median follow‐up period of 42.0 months, the cumulative survival rates of patients were as follows: NGT, 75.6%; IGT, 57.6%; and subclinical DM, 54.8%. Overall, IGT (adjusted hazard ratio [aHR], 1.605; 95% confidence interval [CI] = 1.009–2.553; P = 0.046) and subclinical DM (aHR, 1.840; 95% CI = 1.183–2.861; P = 0.001) were identified as independent predictors of mortality. In patients with compensated cirrhosis (n = 415), neither IGT nor subclinical DM conferred a higher mortality risk. However, among patients with decompensated cirrhosis (n = 298), those with IGT (aHR, 2.394; P = 0.015) and subclinical DM (aHR, 2.211; P = 0.022) showed a survival rate worse than those with NGT. In addition, subclinical DM was identified as an independent risk factor for infection (aHR, 2.508; P = 0.007).ConclusionsIGT and subclinical diabetes by OGTT are associated with an unfavorable prognosis in cirrhosis, and the effect is pronounced in the decompensated state.ClinicalTrials.gov, Number NCT04828512 (https://clinicaltrials.gov/ct2/show/NCT04828512).

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“…In addition, the levels of Hb A 1C and of HOMA-R are increased in DM patients with chronic liver damage and who are undergoing angiopathy [50]. Moreover, since the diabetic condition is associated with a significant increase of mortality in patients with compensated liver cirrhosis [51], there exists a consensus that cirrhosis will negatively impact DM installation and, in turn, DM could shorten the life of patients with the combined pathology. However, the incidence of diabetic retinopathy and cerebrovascular disease was significantly lower in the a diabetic/cirrhotic group compared to the type 2 DM group, probably due to the lower levels of serum lipoprotein A found in the combined group [52].…”

Section: Discussionmentioning

confidence: 99%

Oxidant Status and Lipid Composition of Erythrocyte Membranes in Patients with Type 2 Diabetes, Chronic Liver Damage, and a Combination of Both Pathologies

Hernández‐Muñoz

Olguín-Martínez

Aguilar-Delfín

et al. 2013

Oxidative Medicine and Cellular Longevity

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There is an important set of cirrhotic and diabetic patients that present both diseases. However, information about metabolic and cellular blood markers that are altered, in conjunction or distinctively, in the 3 pathological conditions is scarce. The aim of this project was to evaluate several indicators of prooxidant reactions and the membrane composition of blood samples (serum and red blood cells (RBCs)) from patients clinically classified as diabetic (n = 60), cirrhotic (n = 70), and diabetic with liver cirrhosis (n = 25) as compared to samples from a similar population of healthy individuals (n = 60). The results showed that levels of TBARS, nitrites, cysteine, and conjugated dienes in the RBC of cirrhotic patients were significantly increased. However, the coincidence of diabetes and cirrhosis partially reduced the alterations promoted by the cirrhotic condition. The amount of total phospholipids and cholesterol was greatly enhanced in the patients with both pathologies (between 60 and 200% according to the type of phospholipid) but not in the patients with only one disease. Overall, the data indicate that the cooccurrence of diabetes and cirrhosis elicits a physiopathological equilibrium that is different from the alterations typical of each individual malady.

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The impact of diabetes mellitus in mortality of patients with compensated liver cirrhosis-a prospective study

Cited by 53 publications

References 36 publications

Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study

Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study

Subclinical diabetes confirmed by 75‐g OGTT influence on the prognosis of decompensated cirrhosis

Oxidant Status and Lipid Composition of Erythrocyte Membranes in Patients with Type 2 Diabetes, Chronic Liver Damage, and a Combination of Both Pathologies

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