Gastroenterology
Volume 126, Issue 2 , Pages 460-468, February 2004

Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma

  • Hashem B. El-serag

      Affiliations

    • Corresponding Author InformationHashem B. El-Serag, M.D., M.P.H., The Houston Veterans Affairs Medical Center (152), 2002 Holcombe Boulevard, Houston, Texas 77030, USA; fax: (713) 748-7359
    • The Sections of Gastroenterology and Health Services Research at the Houston Department of Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
    • Dr. El-Serag is a VA HSR&D Awardee (RCD00-013-2).
    • ,
  • Thomas Tran

      Affiliations

    • Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
    • ,
  • James E. Everhart

      Affiliations

    • National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, Maryland, USA

Received 2 June 2003; accepted 13 October 2003.

Abstract 

An association between diabetes and chronic liver disease has been reported. However, the temporal relationship between these conditions remains unknown. We identified all patients with a hospital discharge diagnosis of diabetes between 1985 and 1990 using the computerized records of the Department of Veterans Affairs. We randomly assigned 3 patients without diabetes for every patient with diabetes. We excluded patients with concomitant liver disease. The remaining cohort was followed through 2000 for the occurrence of chronic nonalcoholic liver disease (CNLD) and hepatocellular carcinoma (HCC). Hazard rate ratios (HRR) were determined in Cox proportional hazard survival analysis. The study cohort comprised 173,643 patients with diabetes and 650,620 patients without diabetes. Most were men (98%). Patients with diabetes were older (62 vs. 54 years) than patients without diabetes. The incidence of chronic nonalcoholic liver disease was significantly higher among patients with diabetes (incidence rate: 18.13 vs. 9.55 per 10,000 person-years, respectively, P < 0.0001). Similar results were obtained for HCC (incidence rate: 2.39 vs. 0.87 per 10,000 person-years, respectively, P < 0.0001). Diabetes was associated with an HRR of 1.98 (95% CI: 1.88 to 2.09, P < 0.0001) of CNLD and an HRR of 2.16 (1.86 to 2.52, P < 0.0001) of hepatocellular carcinoma. Diabetes carried the highest risk among patients with longer than 10 years of follow-up. Among men with diabetes, the risk of CNLD and HCC is doubled. This increase in risk is independent of alcoholic liver disease, viral hepatitis, or demographic features.

Abbreviations:  BIRLS, The Beneficiary Identification and Records Locator Subsystem, CNLD, chronic nonalcoholic liver disease, DM, diabetes mellitus, HCC, hepatocellular carcinoma, HCV, hepatitis C virus

 

PII: S0016-5085(03)01733-5

doi:10.1053/j.gastro.2003.10.065

Gastroenterology
Volume 126, Issue 2 , Pages 460-468, February 2004