title: Impact of metformin on the prognosis of cirrhosis induced by viral hepatitis C in diabetic patients.
abstract: BACKGROUND
  Insulin resistance plays a role in hepatocarcinogenesis and is decreased by metformin treatment.
  
  
  OBJECTIVE
  The aim of the study was to assess the influence of metformin treatment on the prognosis of compensated hepatitis C virus (HCV) cirrhosis in patients with type 2 diabetes.
  
  
  METHODS
  We studied an observational prospective cohort (1988-2007) at a university hospital referral center.
  
  
  METHODS
  A total of 100 consecutive diabetic patients (53 men, age 61 ± 11 yr) with ongoing HCV cirrhosis and no contraindication for metformin were included in a screening program for hepatocellular carcinoma (HCC).
  
  
  RESULTS
  The patients were prospectively followed up for HCC incidence, liver-related death, or hepatic transplantation.
  
  
  RESULTS
  The level of platelet count was significantly lower in patients treated with metformin (n = 26) compared with those not treated with metformin (n = 74) [117 (interquartile range, 83-166) vs. 149 (105-192) Giga/liter, P = 0.045]. During a median follow-up of 5.7 (3.8-9.5) yr, one patient was lost to follow-up, 39 developed a HCC, and 33 died from liver causes or were transplanted. The 5-yr incidence of HCC was 9.5 and 31.2% (P = 0.001) and of liver-related death/transplantation, 5.9 and 17.4% (P = 0.013), in patients who received metformin treatment and in those who did not, respectively. In multivariate analysis, metformin treatment was independently associated with a decrease in HCC occurrence [hazard ratio, 0.19 (95% confidence interval, 0.04-0.79); P = 0.023] and liver-related death or transplantation [hazard ratio, 0.22 (95% confidence interval, 0.05-0.99); P = 0.049].
  
  
  CONCLUSIONS
  In patients with type 2 diabetes and HCV cirrhosis, use of metformin is independently associated with reduced incidence of HCC and liver-related death/transplantation.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Department of Hepato-Gastroenterology and Paris-Nord University, Centre de Recherche en Nutrition Humaine de l'Ile-de-France (CRNH-IdF), 93143 Bondy, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Nkontchou
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Cosson
authors.forename: Mounir
authors.initials: M
authors.lastname: Aout
authors.forename: Amel
authors.initials: A
authors.lastname: Mahmoudi
authors.forename: Valérie
authors.initials: V
authors.lastname: Bourcier
authors.forename: Iliass
authors.initials: I
authors.lastname: Charif
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrie
authors.forename: Véronique
authors.initials: V
authors.lastname: Grando-Lemaire
authors.forename: Eric
authors.initials: E
authors.lastname: Vicaut
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Trinchet
authors.forename: Michel
authors.initials: M
authors.lastname: Beaugrand
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D019698:Hepatitis C, Chronic / Q000401:mortality*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008103:Liver Cirrhosis / Q000401:mortality* / Q000821:virology; D008113:Liver Neoplasms / Q000401:mortality; D016031:Liver Transplantation / Q000706:statistics & numerical data; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008875:Middle Aged; D015999:Multivariate Analysis; D010976:Platelet Count; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D008687:Metformin