New-onset diabetes accelerates the pace of liver disease in people with chronic HBV

Michael Carter
02 October 2013

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.


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.”


Huang Y-W et al. Increased risk of cirrhosis and its decompensation in chronic hepatitis B patients with new onset diabetes: a nationwide cohort study. Clin Infect Dis, online edition, 2013.