Risk factors for hepatocellular carcinoma in diabetes
The latest issue of the American Journal of Gastroenterology investigates the risk of hepatocellular carcinoma in diabetic patients, and risk reduction associated with anti-diabetic therapy.
Dr Fung-Chang Sung and colleagues from Taiwan, USA used population-based representative insurance claims data to examine the risk of developing hepatocellular carcinoma among diabetes mellitus patients.
The team also investigates whether diabetic medications alter the risk of developing hepatocellular carcinoma.
From the Taiwan National Health Insurance Research Database, 19,349 newly diagnosed diabetic patients 20 years and older, and 77,396 comparison subjects without diabetes were identified from claims from 2000 to 2005.
The incidences of hepatocellular carcinoma at the end of 2008, and the risks associated with hepatitis B and hepatitis C were determined.
The researchers measured whether metformin and thiazolidinediones reduce the risk of developing hepatocellular carcinoma.
The hazard ratio increased to 72.4 among patients with diabetes
American Journal of Gastroenterology
The team found that the incidence of hepatocellular carcinoma was twice higher in the diabetes group compared with the non-diabetes group, with an adjusted hazard ratio of 1.7.
The researchers observed that male sex, cirrhosis, hepatitis B, and hepatitis C were significant independent factors that predict hepatocellular carcinoma, with hazard ratios of 2.3, 8.7, 2.5, and 5.6, respectively.
In the stratified analysis, the team found that the hazard ratio increased to 72.4 among patients with diabetes, cirrhosis, and hepatitis C.
Hepatocellular carcinoma risk reduction was greater for diabetics taking metformin than those taking thiazolidinediones.
Dr Fung-Chang Sung's team concluded, "Comorbidity with cirrhosis and/or hepatitis appears to be associated with an extremely increased risk of developing hepatocellular carcinoma among diabetic patients."
"These high-risk patients should be closely monitored for hepatocellular carcinoma."
"The use of metformin or thiazolidinediones may reduce the risk of developing hepatocellular carcinoma."
Am J Gastroenterol 2012; 107:46–52
19 January 2012
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