title: Diabetes Is Associated with Clinical Decompensation Events in Patients with Cirrhosis.
abstract: Liver cirrhosis is a leading cause of morbidity and mortality in the USA. Diabetes is common and increasing in incidence. Patients with compensated cirrhosis and diabetes may be at greater risk of clinical decompensation. We examined the risk of decompensation among a large sample of working-aged insured patients dually diagnosed with compensated cirrhosis and diabetes.
  
  
  
  This retrospective study used MarketScan®Commercial Claims and Encounters and Medicare Supplemental Databases (2000-2013). Decompensation events included incident ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, acute renal failure, and hepatocellular carcinoma. Dually diagnosed patients were defined as patients with cirrhosis and diabetes using previously published ICD-9 coding strategies. Adjusted odds ratios (ORs), hazard ratios (HRs), and confidence intervals (CI) were estimated using logistic regression and Cox proportional hazard models.
  
  
  
  Of 72,731 patients with compensated cirrhosis, 20,477 patients (28.15 %) were diagnosed with diabetes. After controlling for patient characteristics and medication usage, the odds of developing any decompensation event were 1.14 times higher for patients with cirrhosis and diabetes than for patients with cirrhosis only (95 % CI 1.08-1.21, P value <0.01). In the Cox proportional hazard model, patients who were dually diagnosed with diabetes had a 1.32 times higher HR (95 % CI 1.26-1.39, P value <0.01) after controlling for time-to-event.
  
  
  
  Patients dually diagnosed with compensated cirrhosis and diabetes had a higher risk of having decompensation events. Careful management of diabetes in patients with liver disease may reduce the risk of clinical decompensation in this population.
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Tsai-Ling
authors.initials: TL
authors.lastname: Liu
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101B McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Trogdon
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105B McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA.|Durham VAMC Center for Health Services Research, Durham, NC, USA.
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.affiliation: Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1104E McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Fried
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 8004 Burnett Womack, CB #7584, Chapel Hill, NC, 27599-7584, USA. sid_barritt@med.unc.edu.
authors.forename: A Sidney
authors.initials: AS
authors.lastname: Barritt
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology; D000328:Adult; D000368:Aged; D001201:Ascites / Q000453:epidemiology* / Q000209:etiology; D001424:Bacterial Infections / Q000453:epidemiology* / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000209:etiology; D015897:Comorbidity; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004932:Esophageal and Gastric Varices / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007348:Insurance, Health; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016017:Odds Ratio; D010538:Peritonitis / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: Liver diseases; Multiple chronic conditions; Secondary data