Hepatology: When chronic hepatitis B meets diabetes, controlling this factor can improve liver-related adverse outcomes!

▎WuXi AppTec content team editor

As of 2015, chronic hepatitis B infection (CHB) affected 292 million people worldwide and caused 890,000 deaths from liver-related complications
such as cirrhosis and liver cancer.
Type 2 diabetes is common in CHB patients and is associated with
an increased risk of cancer, including liver cancer.
One meta-analysis showed that the prevalence of type 2 diabetes was 8.
2%, while the prevalence of type 2 diabetes could be as high as 42.
9%
in patients with CHB associated metabolic-associated fatty liver disease (MAFLD).

A recent study published in Hepatology evaluated factors
associated with liver cancer and fibrosis progression in patients with CHB combined type 2 diabetes.
The results showed that in patients with CHB and type 2 diabetes, high glycemic load was strongly associated
with liver cancer and fibrosis progression.

Professor Szeto Weiji and Professor Yuan Mengfeng of Queen Mary Hospital, University of Hong Kong, China, are the corresponding authors
of the study.

Screenshot source: Hepatology

The study prospectively included 2330 Chinese CHB patients treated at a tertiary care center in Hong Kong, with an average age of 54.
6±11.
8 years, of which 55.
5% were men and 57.
9% received antiviral therapy
.
There were 671 patients (28.
8%) with CHB and type 2 diabetes mellitus (mean duration of type 2 diabetes 7.
2±4.
6 years, mean HbA1c 7.
2±0.
9%)
.
Transient elastography is used to determine liver cancer incidence and fibrosis progression
.
and follow-up for at least 3 years
.

Diagnostic criteria for co-2 diabetes are fasting blood glucose ≥ 7.
0 mmol/L, glycated hemoglobin ≥ 6.
5%, or antidiabetic medication
.

Exclusion criteria were: chronic hepatitis C or D infection, HIV infection, Wilson disease, autoimmune hepatitis, primary cholangitis, primary sclerosing cholangitis, heavy alcohol consumption (defined as daily alcohol consumption ≥3 in men and ≥2 in women), and previous history of liver cancer, liver transplantation, or hepatic decompensation events (defined as variceal bleeding, symptomatic ascites, or HE).

Clinical data
including age, sex, smoking, concomitant metabolic disorders and drug therapy, and diabetes complications were recorded.

The results show:

• In the whole cohort, type 2 diabetes mellitus was independently associated with the occurrence of liver cancer by Cox regression analysis (HR 2.
  080, 95% CI 1.
  343~3.
  222, P=0.
  001).
  
  At 6 years of follow-up, the cumulative incidence of liver cancer in patients with CHB with or without type 2 diabetes mellitus was 4.
  92% and 3.
  74%, respectively (P=0.
  001).
  
  

▲Cumulative incidence of liver cancer in patients with CHB with or without type 2 diabetes (Image source: Reference [1])

• To analyze the factors associated with the occurrence of liver cancer in patients with CHB and type 2 diabetes, the investigators further analyzed
  this subgroup.
  

CHB with type 2 diabetes who developed HCC smoked more often, had a longer course of type 2 diabetes, had a higher mean HbA1c, had a lower time to reach target HbA1c, had higher bilirubin, were more likely to receive sulfonylureas and antiviral therapy, and had a higher
liver stiffness at baseline.
In contrast, there were no significant differences in
age, sex, HbA1c variability, HBV DNA, hepatitis B surface antigen quantification (qHBsAg), alanine aminotransferase (ALT), and controlled attenuation parameters between patients with and without HCC.

• Binary logistic regression analysis showed that type 2 diabetes mellitus was independently associated with fibrosis progression (OR 4.
  305, 95% CI 3.
  416~5.
  424, P<0.
  001).
  
  

To analyze the factors associated with fibrosis progression in CHB combined with type 2 diabetes, further analysis
was also conducted.

Univariate analysis showed that glycaeemic load-related factors (duration of type 2 diabetes, baseline fasting blood glucose, baseline HbA1c, mean HbA1c, time to target HbA1c), body mass index (BMI), waist circumference, alanine aminotransferase, aspartate aminotransferase, bilirubin, antiviral therapy, controlled attenuation parameters, and non-insulin secretagogues were associated
with fibrosis progression.

In summary, in patients with CHB and type 2 diabetes, hyperglycemic load is associated with liver cancer development and fibrosis progression, highlighting the importance of
glycemic control in reducing liver-related complications.