J-Shaped Association between Glycemic Control and the Risk of Hepatocellular Carcinoma in Chronic Hepatitis B Patients with Diabetes Mellitus - a Territory-Wide Cohort Study of 29,221 Subjects
Refereed conference paper presented and published in conference proceedings



摘要Background: Diabetes mellitus (DM) doubles the risk of hepatocellular carcinoma (HCC) in patients with chronic hepatitis B (CHB). This territory-wide cohort study evaluated the impact of glycemic control over time on HCC development in CHB patients with DM.

Methods: We performed a retrospective study on all CHB patients with DM who received medical care from January 2000 to December 2017 in Hospital Authority, Hong Kong. The presence of DM was defined by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code, hemoglobin A1c (HbA1c) ≥6.5%, fasting glucose ≥7mmol/L in two measurements or ≥11.1mmol/L in one measurement, and/or treatment with any anti-diabetic agents. Patients’ demographics, comorbidities, medication, laboratory parameters and HCC diagnosis were captured and analyzed. Overall glycemic control was summarized by time-weighted mean HbA1c during follow-up. The nonlinear relationship between time-weighted mean HbA1c and HCC was evaluated by restricted cubic spline with three knots. Patients with follow-up <6 months, renal replacement therapy, and estimated glomerular filtration rate <30 mL/min/1.73 m2 at baseline were excluded.

Results: We identified 29,221 CHB patients with DM; their mean age was 57.7±11.7 years; 61.1% were male and 11.4% had liver cirrhosis. The median (interquartile range [IQR]) number of HbA1c measurements during follow-up was 10 (5–17); the time-weighted mean HbA1c was 7.2±1.2%. At a median (IQR) follow-up of 7.2 (3.8–11.9) years, 2,703 (9.3%) patients developed HCC. The 15-year cumulative incidence of HCC was 16.7% (95% confidence interval [CI] 16.0%–17.4%). A J-shaped curvilinear association between time-weighted mean HbA1c and HCC development was,observed; patients with HbA1c between 7% and 8% over time,had the lowest risk of HCC after adjustment of age, gender, cirrhosis, laboratory parameters, use of anti-diabetic agents,,statins, antihypertensives, antiplatelets, and antiviral therapy. Compared to time-weighted mean HbA1c of 7–8%, the risk of,HCC increased significantly in patients with time-weighted mean HbA1c ≥10% (adjusted hazard ratio 1.22, 95% CI 1.07–1.40; P=0.003); the risk of HCC was also significantly higher in patients with time-weighted mean HbA1c of 6–6.5% (1.11, 1.04–1.18; P=0.003) (Figure 1).

Conclusion: Poor glycemic control is a risk factor of HCC in CHB diabetic patients; excessively low HbA1c levels over time may be potentially harmful.
著者Terry Cheuk-Fung Yip, Vincent Wai-Sun Wong, Henry Lik-Yuen Chan, Yee-Kit Tse, Grace Lai-Hung Wong
會議名稱The American Association for the Study of Liver Diseases (AASLD) Liver Meeting 2018
會議地點San Francisco
期次Suppl 1
頁次1203A - 1203A

上次更新時間 2020-11-08 於 05:25