Younger-onset type 2 diabetes increases risk for liver-related events
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LONDON — Younger-onset type 2 diabetes increased the risk for liver-related events among patients with nonalcoholic fatty liver disease, according to research presented at the International Liver Congress.
“Earlier this year, we reported that among patients with NAFLD and type 2 diabetes, over 90% developed cirrhotic complications and hepatocellular carcinoma after the age of 50. Meanwhile, numerous studies have shown that young-onset type 2 diabetes has increased rapidly in the past two decades,” Terry Yip, PhD, assistant professor, and Xinrong Zhang, PhD candidate, both of The Chinese University of Hong Kong, told Healio. “We are therefore interested to know if the age at diabetes onset makes a difference.”
In a retrospective, territory-wide cohort study, Zhang and colleagues analyzed data from 30,360 patients with NAFLD (mean age, 56.4 years; 46% men). The primary endpoint was incidence of HCC and cirrhotic complications. Over a follow-up of 151,051 person-years, researchers observed 15,430 cases of type 2 diabetes (T2D) and 456 liver-related events.
According to study results, liver-related events occurred in 1.05 patients per 1,000 person-years among patients without T2D at age 60, in 2.9 patients with T2D onset less than 5 years earlier, in 2.77 patients with T2D onset 6 years to 10 years earlier and in 4.26 patients with T2D onset more than 10 years earlier. Compared with patients who did not have T2D at age 60, adjusted HRs for liver-related events at these time intervals were 2.58 (95% CI, 1.49-4.45), 2.7 (95% CI, 1.45-5.03) and 5 (95% CI, 2.35-10.6), respectively, per multivariable analysis.
“Using a landmark analysis at different age of interest, we consistently showed that earlier age at diabetes onset was associated with an increased risk of cirrhotic complications, HCC and liver-related death in patients with NAFLD. In addition, patients with young-onset type 2 diabetes (onset before the age of 40) had worse glycemic control,” Yip and Zhang said.
“Health care providers should be aware of this association and manage the metabolic profile of patients with young-onset type 2 diabetes aggressively. We learned from previous studies that patients with young-onset type 2 diabetes tend to have more severe insulin resistance, a faster disease progression and lower adherence to treatment; these can all be tackled by patient counseling and the use of newer anti-diabetic drugs and combination treatments as appropriate.
“On the liver side, we encourage clinicians to screen patients with type 2 diabetes for advanced liver disease in line with the recommendations of the clinical care pathway of the AGA,” they added.
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Zhang X, et al. Abstract OS043. Presented at: International Liver Congress; June 22-26, 2022; London (hybrid meeting).
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