medwireNews: Individuals with type 2 diabetes have an increased risk for major adverse liver outcomes (MALOs) that varies according to which additional metabolic syndrome traits they are also diagnosed with, Swedish study findings indicate.
Writing in Diabetes Care, Ying Shang (Karolinska Institutet, Stockholm) and co-authors say their findings highlight “the importance of adequately treating not only hyperglycemia in patients with [type 2 diabetes] to reduce diabetes-related complications but also other comorbidities to reduce the risk for liver-related outcomes.”
Their registry-based study included data for 230,992 patients (median age 64 years, 58% men) with type 2 diabetes and no history of liver disease. The additional metabolic syndrome traits, as defined by the World Health Organization, were hypertension in 92.4% of participants, hypertriglyceridemia in 49.4%, obesity in 46.5%, albuminuria in 19.6%, and low high-density lipoprotein (HDL) levels in 16.2%.
During a median 9.9 years of follow-up, 3215 (1.4%) patients developed a MALO, including cirrhosis, decompensated cirrhosis and its associated complications (chronic or unspecified hepatic failure, esophageal varices with or without bleeding, portal hypertension, hepatorenal syndromes, or liver transplant), hepatocellular carcinoma, or death from any of these.
The researchers report that the incidence of MALOs was significantly higher among the individuals with at least one additional metabolic syndrome trait than among those with only type 2 diabetes, at 1.46 versus 0.56 cases per 1000 person–years.
After adjustment for potential confounders, the risk for MALOs was a significant 2.33-fold higher in patients with type 2 diabetes plus one or more other metabolic syndrome traits than in those with type 2 diabetes only.
Furthermore, Shang et al observed that the risk for MALOs increased with the number of metabolic syndrome traits. Specifically, the 10-year cumulative incidence of MALOs was 0.49% for patients with only type 2 diabetes, and increased to 0.87%, 1.24%, 1.23%, 1.57%, and 1.64% for those with one, two, three, four, and five additional traits, respectively.
This corresponded to a significant 28% increased risk for MALOs with each additional metabolic syndrome trait beyond type 2 diabetes, after adjustment for potential confounders.
For individuals with all five additional metabolic syndrome traits at baseline, the risk for MALOs was a significant 4.09-times higher than for those with diabetes only.
The investigators also explored how each individual metabolic syndrome trait impacted MALO risk. They found that hypertension conferred the greatest risk, with a significant adjusted hazard ratio (aHR) of 2.06 for people with diabetes plus hypertension relative to those with diabetes only.
The aHRs were a significant 1.38 for obesity, 1.37 for low HDL levels, 1.23 for albuminuria, and 1.11 for hypertriglyceridemia.
This shows that “[t]reating and preventing hypertension and obesity are particularly crucial to prevent the development of cirrhosis in this population,” Shang and colleagues remark.
They conclude: “The findings from this study may aid in identifying subgroups at high risk of developing future liver disease, which would be particularly efficient for targeted screening initiatives.”
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