1Middlemore Hospital, Counties Manukau District Health Board, South Auckland, New Zealand.
The effect of type 2 diabetes mellitus (DM) on morbidity and mortality among hepatitis B (HBV) cirrhosis patients is poorly defined. We assess the effect of DM on the HBV cirrhosis outcomes and survival.
A retrospective study of HBV cirrhosis patients who sought care at a sole public hospital in a geographically defined region, from year 2000 to 2012. Cirrhosis complications, liver transplantations, and mortality were reviewed. Primary outcome is the composite of liver-related and overall mortality or liver transplantation (OLT).
223 patients entered into the final analysis; 50 patients (22.4%) have DM at cirrhosis diagnosis. 72% of DM patients have DM for more than five years at cirrhosis diagnosis. The incidence of hepatocellular carcinoma (HCC) was 25.4 and 60.5 per 1,000 patient-years for non-DM and DM patients, respectively (p=0.006). In multivariate analysis, DM was a predictor of HCC (Hazard ratio (HR) 2.36, [1.14-4.85], p=0.02), hepatic complications (HR 2.04, [1.16-3.59], p=0.01), liver mortality or OLT (HR 2.26, [1.05-4.86], p=0.04) and overall mortality or OLT (HR 2.25, [1.96-4.22], p=0.01). Insulin and/or sulphonylurea use and poor diabetic control (HbA1c≥7.0%) were predictors of HCC, and cirrhosis complications (all p<0.05). The five-year liver-related mortality or OLT rate was 23.4% for DM patients, and 9.4% for non-DM patients, respectively (p=0.009).
The presence of DM and poor diabetic control at cirrhosis diagnosis significantly increase the rate of cirrhosis complications and reduced survival in patients with HBV-cirrhosis. Improving diabetic control should be essential part of the cirrhosis care in these patients.