Association of type 2 diabetes with liver cirrhosis: a nationwide cohort study

// Ping-Hsin Hsieh 1 , Jing-Yang Huang 2 , Oswald Ndi Nfor 2 , Chia-Chi Lung 2 , Chien-Chang Ho 4 and Yung-Po Liaw 2,3 1 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chi-Mei Medical Center, Tainan, Taiwan 2 Department of Public Health and Institute of Public Health, Chung Shan Medical University, Taichung, Taiwan 3 Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan 4 Department of Physical Education, Fu-Jen Catholic University, New Taipei, Taiwan Correspondence to: Yung-Po Liaw, email: // Keywords : alcohol, cirrhosis, type 2 diabetes, public health, prevention Received : January 09, 2017 Accepted : April 18, 2017 Published : June 13, 2017 Abstract Background: The link between the subcategories of liver cirrhosis and type 2 diabetes is not well known. We investigated the association of type 2 diabetes mellitus with alcoholic cirrhosis and cirrhosis without alcohol. Methods: This nationwide cohort study used the Taiwan National Health Insurance Research Database. Cirrhotic individuals and their matched controls were identified from 2001-2008. In all, 9 313 cirrhotic patients aged 20 years or older were matched by age, sex, and index date with the non-cirrhotic individuals ( n = 37 252). Cirrhosis was categorized into alcoholic cirrhosis and cirrhosis without alcohol. Type 2 diabetes mellitus was identified from January 2001- December 2011. Results: The incidence densities (per 1 000 person-months) of type 2 diabetes were as follows: 1.14 (95% CI: 1.09-1.20) in the non-cirrhotic group, 1.88 (CI 1.76-2.01) in patients with cirrhosis, 1.62 (CI 1.48-1.78) in patients with cirrhosis without alcohol, and 2.92 (CI 2.64-3.23) in patients with alcoholic cirrhosis. The adjusted hazards ratio (aHR) for type 2 diabetes mellitus among cirrhotic individuals was 0.774 (CI: 0.715-0.8934). Alcoholic cirrhotic men had a significantly higher risk of type 2 diabetes (aHR 1.182, CI: 1.046-1.335) compared with non-cirrhotic individuals. Increased risks were seen in men (aHR 1.690; CI: 1.455-1.963) and women (aHR 1.715; CI: 1.113-2.645) with alcoholic cirrhosis compared to those with cirrhosis without alcohol. Conclusions: This study indicates that alcoholic cirrhosis is a significant risk factor for type 2 diabetes mellitus compared with cirrhosis without alcohol.