Type 2 diabetes: A risk factor for liver mortality and complications in hepatitis B cirrhosis patients

Background and Aim 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