T2D doubles risk for severe LD

  • Björkström K & al.
  • Clin Gastroenterol Hepatol
  • 19 Apr 2019

  • International Clinical Digest
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Takeaway

  • People with type 2 diabetes (T2D) have more than twice the risk for severe liver disease (SLD) than the general population.

Why this matters

  • Nonalcoholic fatty liver disease is expected to become the primary indication for liver transplantation in the United States in the coming decade.

Study design

  • Swedish National Diabetes Register data for 406,770 people with T2D matched with the general population (n=2,033,850) by age, sex, and county.
  • SLD defined as any cirrhosis, decompensated cirrhosis, hepatocellular carcinoma (HCC), hepatic failure, liver transplantation, or liver disease-related death.
  • Funding: Non-industry Swedish sources.  

Key results

  • During median follow-up of 7.7 years, 1.3% with T2D and 0.6% of control patients developed SLD (P<.001>
  • HRs in T2D vs controls were:
    • 2.28 for SLD,
    • 3.18 for HCC, and
    • 2.29 for liver disease-related death (all P<.001>
  • More SLD events occurred in:
    • Men with T2D: 1.40% vs 1.08% women;
    • Respective HRs vs controls: 2.37 (95% CI, 2.27-2.48) and 2.15 (2.04-2.27), respectively.
  • Higher age, smoking, male sex, hypertension, higher BMI, lower glomerular filtration rate, and microalbuminuria all independently increased SLD risk.
  • Statins, higher low-density lipoprotein, and female sex independently lowered SLD risk.

Limitations

  • Lack of risk factor data in controls.
  • Register-based.
  • Short follow-up.   

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