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Timothy M. E. Davis, Kirsten E. Peters, David G. Bruce, Wendy A. Davis, Prevalence, Incidence, and Prognosis of Hepatobiliary Disease in Community-Based Patients with Type 2 Diabetes: The Fremantle Diabetes Study, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 5, 1 May 2012, Pages 1581–1588, https://doi.org/10.1210/jc.2011-3232
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Few studies have examined morbidity and mortality associated with hepatobiliary disease in diabetes. Most have used administrative databases and/or have had limited/incomplete data including recognized risk factors for hepatobiliary disease.
The objective of the study was to explore the relationship between type 2 diabetes and hepatobiliary disease in well-characterized patients with detailed risk factor data including viral hepatitis status and hemochromatosis genotype.
This was a community-based longitudinal observational study.
The study was conducted in an urban Australian community.
The study included 1294 patients of mean ± sd aged 64.1 ± 11.3 yr and 5156 age-, gender-, and ZIP code-matched nondiabetic controls.
Prevalent and incident hepatobiliary disease and hepatobiliary disease-related death were measured. Competing risks proportional hazard models provided independent associates of these end points.
During 13,705 patient-years (mean 11.5 yr), 144 patients had an initial hepatobiliary disease-related hospitalization/cancer registration vs. 403 controls during 63,937 person-years of follow-up, an incidence rate ratio of 1.66 (95% confidence interval 1.37–2.02). Incident hepatobiliary disease was associated with a lower glycosylated hemoglobin and higher urinary albumin to creatinine ratio. Nearly half of the patients (49.9%) died during follow-up [crude mortality ratio vs. nondiabetic controls 1.97 (1.16–3.32)], and 21 (3.3%) from hepatobiliary disease including two cases of cirrhosis attributable to nonalcoholic steatohepatitis. Hepatobiliary disease-related death was independently predicted by prior hepatobiliary disease, hepatitis C seropositivity, retinopathy, and peripheral neuropathy; higher educational level and higher fasting serum glucose were protective.
Hepatobiliary disease and associated mortality are increased in type 2 diabetes. Multiple factors including fatty infiltration, microangiopathy, and direct glucotoxicity are likely to contribute, but hospitalization and death due to cirrhosis from nonalcoholic steatohepatitis appear uncommon.
