1. Glycaemic control is a modifiable risk factor for hepatocellular carcinoma and liver-related mortality in patients with diabetes.
- Author
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Mao X, Cheung KS, Tan JT, Mak LY, Lee CH, Chiang CL, Cheng HM, Hui RW, Leung WK, Yuen MF, and Seto WK
- Subjects
- Humans, Male, Female, Middle Aged, Aged, Risk Factors, Hong Kong epidemiology, Hypoglycemic Agents therapeutic use, Blood Glucose metabolism, Diabetes Mellitus mortality, Cohort Studies, Diabetes Mellitus, Type 2 mortality, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 blood, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular prevention & control, Liver Neoplasms mortality, Liver Neoplasms prevention & control, Glycated Hemoglobin metabolism, Glycemic Control
- Abstract
Background: Optimal glycaemic control has well-established health benefits in patients with diabetes mellitus (DM). It is uncertain whether optimal glycaemic control can benefit liver-related outcomes., Aims: To examine the association of optimal glycaemic control with hepatocellular carcinoma (HCC) and liver-related mortality., Methods: In a population-based cohort, we identified patients with newly diagnosed DM between 2001 and 2016 in Hong Kong. Optimal glycaemic control was defined as mean haemoglobin A1c (HbA1c) <7% during the 3-year lead-in period after DM diagnosis. By applying propensity score matching to balance covariates, we analysed glycaemic control via competing risk models with outcomes of interest being HCC and liver-related mortality., Results: We identified 146,430 patients (52.2% males, mean age 61.4 ± 11.8 years). During a median follow-up duration of 7.0 years, 1099 (0.8%) and 978 (0.7%) patients developed HCC and liver-related deaths. Optimal glycaemic control, when compared to suboptimal glycaemic control, was associated with reduced risk of HCC (subdistribution hazard ratio [SHR] 0.70, 95% CI 0.61-0.79). The risk of HCC increased with incremental HbA1c increases beyond >7% (SHR 1.29-1.71). Significant associations with HCC were also found irrespective of age (SHR 0.54-0.80), sex (SHR 0.68-0.69), BMI <25 or ≥25 kg/m
2 (SHR 0.63-0.75), smoking (SHR 0.61-0.72), hepatic steatosis (SHR 0.67-0.68) and aspirin/statin/metformin use (SHR 0.67-0.75). A lower risk of liver-related mortality in relation to optimal glycaemic control was also observed (SHR 0.70, 95% CI 0.61-0.80)., Conclusions: Glycaemic control is an independent risk factor for HCC and liver-related mortality, and should be incorporated into oncoprotective strategies in the general DM population., (© 2024 The Author(s). Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.)- Published
- 2024
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