title: Type 2 diabetes: a risk factor for liver mortality and complications in hepatitis B cirrhosis patients.
abstract: OBJECTIVE
  The effect of type 2 diabetes mellitus (DM) on morbidity and mortality among hepatitis B virus (HBV) cirrhosis patients is poorly defined. We assess the effect of DM on the HBV cirrhosis outcomes and survival.
  
  
  METHODS
  A retrospective study of HBV cirrhosis patients who sought care at a sole public hospital in a geographically defined region, from year 2000 to 2012. Cirrhosis complications, liver transplantations, and mortality were reviewed. Primary outcome is the composite of liver-related and overall mortality or orthotopic liver transplantation (OLT).
  
  
  RESULTS
  Two hundred twenty-three patients entered into the final analysis; 50 patients (22.4%) have DM at cirrhosis diagnosis. Seventy-two percent of DM patients have DM for more than 5 years at cirrhosis diagnosis. The incidence of hepatocellular carcinoma (HCC) was 25.4 and 60.5 per 1000 patient-years for non-DM and DM patients, respectively (P = 0.006). In multivariate analysis, DM was a predictor of HCC (hazard ratio [HR] 2.36, [1.14-4.85], P = 0.02), hepatic complications (HR 2.04, [1.16-3.59], P = 0.01), liver mortality or OLT (HR 2.26, [1.05-4.86], P = 0.04), and overall mortality or OLT (HR 2.25, [1.96-4.22], P = 0.01). Insulin and/or sulphonylurea use and poor diabetic control (glycosylated hemoglobin ≥ 7.0%) were predictors of HCC and cirrhosis complications (all P < 0.05). The 5-year liver-related mortality or OLT rate was 23.4% for DM patients and 9.4% for non-DM patients, respectively (P = 0.009).
  
  
  CONCLUSIONS
  The presence of DM and poor diabetic control at cirrhosis diagnosis significantly increase the rate of cirrhosis complications and reduced survival in patients with HBV cirrhosis. Improving diabetic control should be essential part of the cirrhosis care in these patients.
authors.affiliation: Middlemore Hospital, Counties Manukau District Health Board, South Auckland, New Zealand.
authors.forename: John C
authors.initials: JC
authors.lastname: Hsiang
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Gane
authors.forename: Wayne W
authors.initials: WW
authors.lastname: Bai
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Gerred
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors
keywords: chronic hepatitis B; cirrhosis; cirrhosis complications; hepatocellular carcinoma; insulin; liver-related mortality; sulphonylurea; type 2 diabetes mellitus