Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: a nationwide population-based cohort study in Taiwan

Yen, Fu‐Shun; Wei, James Cheng‐Chung; Yip, Hei-Tung; Hwu, Chii‐Min; Hou, Ming‐Chih; Hsu, Ching‐Yun

doi:10.1007/s12072-020-10122-1

Cited by 17 publications

(19 citation statements)

References 26 publications

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“…Our study revealed that insulin use is associated with higher risks of all-cause mortality [aHR 1. (2.45-4.53)] than non-use of insulin (28). Although we cannot completely exclude the bias of cofounding by indication that physicians may choose to prescribe insulin therapy for patients with more severe cirrhosis, our study suggested that in patients with compensated liver cirrhosis, the use of insulin warranted special attention.…”

Section: Insulinmentioning

confidence: 66%

“…Metformin decreases portal pressure, liver injury, and improves hepatic fibrosis in cirrhotic rats (44,45) (28). After propensity score matching, we found that metformin use in patients with compensated cirrhosis is associated with higher risks of mortality [aHR 1.13 (1.01-1.25)] and cirrhotic decompensation [aHR 1.15 (1.04-1.27)] than metformin non-use, and these higher risks were dose dependent.…”

Section: Yen Et Al (26)mentioning

confidence: 85%

“…A recent observational study disclosed that there is no unsafe plasma lactate concentration in patients with chronic liver disease and using metformin ( 43 ). In our previous study, the use of metformin in patients with compensated [adjusted hazard ratio (aHR) 1.01 (0.72–1.42)] or decompensated [aHR 0.94 (0.60–1.46)] liver cirrhosis was not associated with a higher risk of metabolic acidosis than non-use of metformin ( 28 ).…”

Section: Management Of Patients With T2d and Chronic Liver Diseasesmentioning

confidence: 98%

“…Vilar-Gomez et al ( 17 )] investigated 191 patients with diabetes and biopsy-proven NASH and fibrosis or compensated cirrhosis and demonstrated that long-term metformin use reduces the risk of all-cause mortality or liver transplantation [aHR 0.42 (0.24–0.74)] and HCC [aHR 0.25 (0.11–0.58)]. We conducted a nationwide cohort study on 26,164 patients with T2D and compensated liver cirrhosis and 15,056 patients with T2D and decompensated liver cirrhosis ( 28 ). After propensity score matching, we found that metformin use in patients with compensated cirrhosis is associated with higher risks of mortality [aHR 1.13 (1.01–1.25)] and cirrhotic decompensation [aHR 1.15 (1.04–1.27)] than metformin non-use, and these higher risks were dose dependent.…”

Section: Management Of Patients With T2d and Chronic Liver Diseasesmentioning

confidence: 99%

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Selection and Warning of Evidence-Based Antidiabetic Medications for Patients With Chronic Liver Disease

Yen¹,

Hsu

Wei

et al. 2022

Front. Med.

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The global prevalence of chronic liver disease and diabetes mellitus (DM) has gradually increased potentially due to changes in diet and lifestyle. The choice of antidiabetic medications for patients with coexisting DM and chronic liver disease is complicated. Severe liver injury may decrease the metabolism of antidiabetic medications, resulting in elevated drug concentrations and adverse effects. The choice of antidiabetic medications in patients with chronic liver disease has not been well studied. The long-term outcomes of antidiabetic medications in patients with chronic liver disease have gained attention recently. Herein, we reviewed relevant articles to extend our understanding on the selection and warning of antidiabetic medications for patients with chronic liver disease.

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Section: Insulinmentioning

confidence: 66%

Section: Yen Et Al (26)mentioning

confidence: 85%

Section: Management Of Patients With T2d and Chronic Liver Diseasesmentioning

confidence: 98%

Section: Management Of Patients With T2d and Chronic Liver Diseasesmentioning

confidence: 99%

See 2 more Smart Citations

Selection and Warning of Evidence-Based Antidiabetic Medications for Patients With Chronic Liver Disease

Yen¹,

Hsu

Wei

et al. 2022

Front. Med.

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“…The adjusted hazard ratios (aHRs) (95%CI) of variceal bleeding and hepatic failure were 1.67 (1.11-2.52) and 1.35 (1.02-1.79), respectively, for DPP-4 inhibitor users over nonusers. The risk of all-cause mortality, HCC, and major cardiovascular events were not statistically different[ 112 ]. In another population-based, retrospective cohort study including patients with DM and LC treated with GLP-1 receptor agonists (GLP-1RAs), DPP-4 inhibitors, sulfonylureas or sodium-glucose co-transporter-2 (SGLT-2) inhibitors, GLP-1RAs use was associated to significantly reduced number of liver related complications compared to DPP-4 inhibitors and sulfonylureas.…”

Section: Management Of Dm In Lcmentioning

confidence: 99%

Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives

García-Compeán¹,

Orsi²,

Kumar³

et al. 2022

WJG

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Diabetes mellitus (DM) is common in liver cirrhosis (LC). The pathophysiological association is bidirectional. DM is a risk factor of LC and LC is a diabetogenic condition. In the recent years, research on different aspects of the association DM and LC has been intensified. Nevertheless, it has been insufficient and still exist many gaps. The aims of this review are: (1) To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis; (2) To evaluate the impact of DM on outcomes of LC patients; and (3) To select the most adequate management benefiting the two conditions. Literature searches were conducted using PubMed, Ovid and Scopus engines for DM and LC, diagnosis, outcomes and management. The authors also provided insight from their own published experience. Based on the published studies, two types of DM associated with LC have emerged: Type 2 DM (T2DM) and hepatogenous diabetes (HD). High-quality evidences have determined that T2DM or HD significantly increase complications and death pre and post-liver transplantation. HD has been poorly studied and has not been recognized as a complication of LC. The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure. In conclusion, the clinical impact of DM in outcomes of LC patients has been the most studied item recently. Nevertheless many gaps still exist particularly in the management. These most important gaps were highlighted in order to propose future lines for research.

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Diabetes medications and risk of HCC

et al. 2022

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Type 2 diabetes mellitus is a recognized risk factor for HCC in patients with liver disease, independent from the etiology of their liver disease. Hence, prevention and treatment of type 2 diabetes mellitus and its underlying cause, insulin resistance, should be considered a treatment target for patients with liver disease. The drug armamentarium for diabetes is wide and consists of agents with insulin‐sensitizing activity, agents that stimulate insulin secretion, insulin itself, and agents that reduce gastrointestinal and urinary glucose absorption. From an endocrinology perspective, the main goal of treatment is the achievement of euglycemia; however, in patients at risk of, or with known underlying liver disease, the choice of diabetic medication as it relates to potential hepatic carcinogenesis remains complex and should be carefully considered. In the last decade, increasing evidence has suggested that metformin may reduce the risk of HCC, whereas evidence for other classes of diabetic medications, particularly some of the newer agents including the sodium glucose cotransporter‐2 inhibitors and glucagon‐like peptide‐1 receptor agonists, is fewer and often inconsistent. In this review, we aim to summarize the current evidence on the potential effects of the most widely used diabetic agents on liver cancer tumorigenesis.

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Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: a nationwide population-based cohort study in Taiwan

Cited by 17 publications

References 26 publications

Selection and Warning of Evidence-Based Antidiabetic Medications for Patients With Chronic Liver Disease

Selection and Warning of Evidence-Based Antidiabetic Medications for Patients With Chronic Liver Disease

Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives

Diabetes medications and risk of HCC

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