Diabetes and high blood glucose levels in individuals without a diabetes diagnosis correlated with increased risks for liver cancer and major chronic liver diseases, according to a large prospective study of Chinese adults.
“The magnitude of the associated risks for different types of liver diseases and in different populations is not clearly established,” Yuanjie Pang, ScM, from the University of Oxford, and colleagues wrote. “Our finding for diabetes with liver cancer was broadly consistent with those of previous prospective studies in Western and other East Asian populations.”
Between 2004 and 2008, Pang and colleagues prospectively followed 503,993 Chinese individuals. The prevalence of previously diagnosed diabetes was 3.1% and screen-detected diabetes was 2.7%. During 10 years of follow-up, 2,568 patients developed liver cancer, 2,082 developed cirrhosis, 1,298 patients were hospitalized for nonalcoholic fatty liver diseases, and 244 patients were hospitalized for alcoholic liver disease.
Diabetes correlated with significantly increased risks for liver cancer (HR = 1.49; 95% CI, 1.3-1.7), cirrhosis (HR = 1.81; 95% CI, 1.57-2.09), NAFLD (HR = 1.76; 95% CI, 1.47-2.16) and alcoholic liver disease (HR = 2.24; 95% CI, 1.42-3.54).
Regarding patients with incident diabetes after baseline, diabetes remained a significant risk factor for liver cancer (HR = 1.62; 95% CI, 1.34-1.95), cirrhosis (HR = 1.78; 95% CI, 1.45-2.18), NAFLD (HR = 3.39; 95% CI, 2.75-4.18) and alcoholic liver disease (HR = 2.03; 95% CI, 1.11-3.73).
While excess risks decreased over the duration of living with diabetes, the risk factors remained elevated 10 years and more after diagnosis for liver cancer (HR = 1.42), cirrhosis (HR = 1.54) and NAFLD (HR = 1.71).
Patients without previously diagnosed diabetes displayed a positive and log-linear association between each 1 mmol/L of random plasma glucose (RPG) and risk for liver cancer (HR = 1.04; 95% CI, 1.03-1.06), cirrhosis (HR = 1.07; 95% CI, 1.05-1.09) and NAFLD (HR = 1.07; 95% CI, 1.05-1.1).
“The associations for diabetes and RPG did not seem to differ by [hepatitis B surface antigen] status,” the researchers concluded. “Given that the majority of diabetes cases are undiagnosed in China, early detection of diabetes could help identify a group of individuals at increased risk of chronic liver diseases and prevent possible progression to cirrhosis and liver cancer.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.