Glycemic burden and the risk of adverse hepatic outcomes in patients with chronic hepatitis B with type 2 diabetes

Abstract

Background and Aims: Type 2 diabetes (T2D) is common among patients with chronic hepatitis B infection (CHB) and has been associated with increased risk of carcinogenesis, including HCC. We investigated factors associated with HCC and fibrosis progression among patients with CHB with T2D (CHB+T2D). Approach and Results: Chinese patients with CHB were prospectively recruited for the incidence of HCC and fibrosis progression defined by transient elastography. Among patients with CHB+T2D, glycemic control was assessed by mean glycated hemoglobin (HbA1c) and HbA1c variability determined using HbA1c measurements in the 5 years preceding recruitment. A total of 2330 patients with CHB were recruited (mean age 54.6 ±11.8 years old, 55.5% male, 57.9% antiviral‐treated), with 671 (28.8%) having CHB+T2D (mean T2D duration 7.2 ± 4.6 years, mean HbA1c 7.2 ± 0.9%). T2D was independently associated with HCC (HR 2.080, 95% CI 1.343–3.222) and fibrosis progression (OR 4.305, 95% CI 3.416–5.424) in the overall cohort. In patients with CHB+T2D, factors reflecting glycemic burden (T2D duration [HR 1.107, 95% CI 1.023–1.198]), mean HbA1c (HR 1.851, 95% CI 1.026–3.339), time reaching target HbA1c (HbA1c‐TRT; HR 0.978, 95% CI 0.957–0.999), liver stiffness (HR 1.041–1.043), and smoking (HR 2.726–3.344) were independently associated with HCC (all p < 0.05), but not HbA1c variability or controlled attenuation parameter. The same glycemic burden–related factors (T2D duration, mean HbA1c, and HbA1c‐TRT), in addition to baseline fasting glucose, baseline HbA1c, AST and antiviral therapy, were independently associated with fibrosis progression at 3 years. Conclusions: High glycemic burden was associated with HCC development and fibrosis progression among patients with CHB+T2D, highlighting the importance of glycemic control in reducing liver‐related complications.

Reply: Hepatic steatosis and glycemic burden in chronic hepatitis B

“…We sincerely appreciate the letter from Huang and Kao [1] reviewing our recent paper published in Hepatology. [2] We concur with Huang and Kao on the intriguing observation on the relationship between glycemic control and risk of HCC in patients with chronic hepatitis B (CHB) infection and type 2 diabetes (T2D).…”

Eligibility for antiviral therapy and treatment uptake in chronic hepatitis B patients referred to a European tertiary care center

“…Nonetheless, we recommend the universal application of TE in all patients with CHB. Along these lines, data on metabolic comorbidities, 29 the presence of concomitant non‐alcoholic fatty liver disease, 30 and lifestyle‐related risk factors 31 for disease progression were missing in our cohort, which might have influenced the management of some patients. Thus, the true treatment eligibility among our cohort might have been slightly underestimated.…”

Loss of the Novel Mitochondrial Membrane Protein FAM210B Is Associated with Hepatocellular Carcinoma

“…HCC is a complex disease with several potential contributors to its development, including viral infection [ 21 , 22 , 23 , 24 ], mycotoxin exposure [ 25 ], non-alcoholic fatty liver disease [ 26 ], diabetes [ 27 ], smoking [ 28 ], and gene alterations [ 29 , 30 ]. Therefore, it is essential to establish novel treatment approaches to improve the poor prognosis for HCC patients.…”