New-onset diabetes
is associated with the development of liver cirrhosis and decompensated
cirrhosis in people with chronic hepatitis B virus (HBV) infection, according to the results
of a study published in the online edition of Clinical Infectious Diseases.
The population-based study was
conducted in Taiwan and study participants were followed for approximately ten years.
The relationship between new-onset diabetes and the progression of liver
disease persisted after controlling for other risk factors such as age, gender,
the use of HBV therapy and the presence of other serious health conditions.
“Diabetes
accelerates cirrhosis development and its decompensation in chronic hepatitis B
patients,” write the authors.
Glossary
- decompensated cirrhosis
The later stage of
cirrhosis, during which the liver cannot perform some vital functions and
complications occur. See also ‘cirrhosis’ and ‘compensated cirrhosis’.
Findings from
case-control studies have shown that the prevalence of diabetes in people
with chronic HBV increases as liver fibrosis worsens.
However, fibrosis
and cirrhosis may lead to the development of glucose intolerance and diabetes.
Therefore, whether the presence of diabetes actually accelerates cirrhosis is
controversial.
Because of this
uncertainty, a team of investigators in Taiwan designed a longitudinal study
involving people with chronic HBV infection who were identified from national
health insurance records.
Their study
population involved 351 individuals diagnosed with new-onset diabetes between
1999-2000 and 7886 non-diabetic patients who received care between 1997 and
2009. The participants in the study were followed until the development of cirrhosis,
decompensated cirrhosis, withdrawal from the cohort or 2009.
People with
cirrhosis at baseline and those with hepatitis C virus (HCV) co-infection were
excluded from participation.
The people with
new-onset diabetes contributed 2900 person-years of follow-up. During this
period, 38 individuals developed cirrhosis, an incidence rate of 1.31 per
10,000 person years. The non-diabetic patients contributed 73,380 person-years
of follow-up. A total of 208 of these patients developed liver cirrhosis. The
incidence rate was 0.28 per 10,000 person-years of follow-up.
After controlling
for other known risk factors for the progression of liver disease, the
investigators showed that new-onset diabetes was associated with a significant
increase in the risk of developing liver cirrhosis (HR = 2.055; 95% CI,
1.42-297, p < 0.001) and decompensated cirrhosis (HR = 1.81; 95% CI,
1.19-2.70, p < 0.001).
The associations
between new-onset diabetes and the development of cirrhosis remained robust in
an sensitivity analysis that further controlled for age and gender (HR = 1.70;
95% CI, 1.13-2.55, p = 0.001).
The increased risk
of cirrhosis also persisted over time, new-onset diabetes doubling the risk of
serious liver disease after six years of follow-up (HR = 2.29; 95% CI,
1.32-3.94) and by a similar magnitude after nine years of follow-up (HR = 2.30;
95% CI, 1.58-3.5).
“Our data showed
that diabetes preceded cirrhosis development and its decompensation, in some
cases by many years, providing strong support for a causal association,” write
the investigators. “Further studies are needed to evaluate the underlying
pathogenesis of diabetes causing fibrosis progression or cirrhosis in chronic
hepatitis B patients.”
They conclude,
“chronic hepatitis B patients who develop diabetes during follow-up are at an
increased risk of cirrhosis and its decompensation over time and should receive
active management.”