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Incident diabetes increases risk for liver cancer, hepatic diseases

Diabetes and high blood glucose levels among individuals without known diabetes correlated with increased risks for liver cancer and chronic liver disease, according results of a Chinese cohort study.

“The increase in diabetes prevalence is so recent [in China] that its impact on risk of liver cancer and liver diseases, if any, may not yet have fully emerged,” Yuanjie Pang, from the University of Oxford in the United Kingdom, and colleagues wrote. “Our finding linking diabetes with liver cancer was broadly consistent with those of previous prospective studies in Western and other East Asian populations.”

During 10 years of follow-up, Pang and colleagues observed 2,568 cases of liver cancer, 2,082 cases of cirrhosis, 1,298 cases of nonalcoholic fatty liver disease, and 244 cases of alcoholic liver disease among 503,993 participants. The prevalence of previously diagnosed diabetes was 3.1% and screen-detected diabetes was 2.7%.

Diabetes correlated significantly with increased risks for liver cancer (adjusted HR = 1.49; 95% CI, 1.3-1.7), cirrhosis (HR = 1.81; 95% CI ,1.57-2.09), NAFLD (HR = 1.76; 95% CI, 1.47-2.16) and alcoholic liver disease (HR = 2.24; 95% CI, 1.42-3.54) for both patients with a previous diagnosis and those in the screen-detected group.

Among patients with incident diabetes after study baseline, correlations for liver cancer, cirrhosis, and alcoholic liver disease remained significant, especially for NAFLD (HR = 3.39; 95% CI, 2.75-4.18).

Compared with study participants without diabetes, the risks for liver cancer or chronic disease were highest between diabetes diagnosis and less than 2 years from diagnosis. Risks for liver cancer or chronic disease decreased over time but remained significantly elevated 10 or more years after diagnosis.

The researchers also observed a positive correlation between random plasma glucose (RPG) levels per 1 mmol/L and liver cancer (HR = 1.04; 95% CI, 1.03-1.06), cirrhosis (HR = 1.07; 95% CI, 1.05-1.09) and NAFLD (HR = 1.07; 95% CI, 1.05-1.1) among patients without previously detected diabetes.

“The associations for diabetes and RPG did not seem to differ by [hepatitis B surface antigen] status,” Pang and colleagues noted. “Given that the majority of diabetes cases are undiagnosed in China, early detection of diabetes could help identify a group of individuals at increased risk of chronic liver diseases and prevent possible progression to cirrhosis and liver cancer.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.