title: Increased risk of cirrhosis and its decompensation in chronic hepatitis C patients with new-onset diabetes: a nationwide cohort study.
abstract: The effect of diabetes on cirrhosis, its decompensation, and their time relationship in chronic hepatitis C (CHC) patients remains unclear. We conducted a nation-wide cohort study by using the Taiwanese National Health Insurance Research Database, which is comprised of data from >99% of the entire population. Among having randomly sampled 1 million enrollees, 6,251 adult CHC patients were identified from 1997 to 2009. Diabetes was defined as new onset in CHC patients who were given the diagnosis in the years 1999-2003, but not in 1997-1998. The cohorts of CHC with new-onset diabetes (n=424) and nondiabetes (n=1,708) were followed up from inception point in diabetes and from year 1999 in the nondiabetes cohort until development of cirrhosis or its decompensation, withdrawal from insurance, or December 2009. Kaplan-Meier's survival analysis showed a significantly higher cumulative incidence of cirrhosis (relative risk [RR]=1.53; 95% confidence interval [CI]=1.11-2.11; log-rank test; P<0.001) and decompensated cirrhosis (RR=2.01; 95% CI=1.07-3.79; log-rank test; P<0.001) among patients with new-onset diabetes, as compared to those without. After adjustment for age, gender, CHC treatment, diabetes treatment, hepatocellular carcinoma, comorbidity index, hypertension, hyperlipidemia, and obesity by Cox's proportional hazard model, diabetes was still an independent predictor for cirrhosis (hazard ratio [HR]=2.505; 95% CI=1.609-3.897; P<0.001) and its decompensation (HR=3.560; 95% CI=1.526-8.307; P=0.003).
  
  
  CONCLUSIONS
  CHC patients who develop diabetes are at an increased risk of liver cirrhosis and its decompensation over time.
authors.affiliation: Liver Center, Cathay General Hospital Medical Center, Taipei, Taiwan; School of Medicine, Taipei Medical University College of Medicine, Taipei, Taiwan; Division of Gastroenterology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Huang
authors.forename: Sien-Sing
authors.initials: SS
authors.lastname: Yang
authors.forename: Szu-Chieh
authors.initials: SC
authors.lastname: Fu
authors.forename: Ting-Chuan
authors.initials: TC
authors.lastname: Wang
authors.forename: Cheng-Kai
authors.initials: CK
authors.lastname: Hsu
authors.forename: Ding-Shinn
authors.initials: DS
authors.lastname: Chen
authors.forename: Jui-Ting
authors.initials: JT
authors.lastname: Hu
authors.forename: Jia-Horng
authors.initials: JH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000821:virology; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult