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Hyperglycemia and chronic liver diseases on risk of hepatocellular carcinoma in Chinese patients with type 2 diabetes––National cohort of Taiwan Diabetes Study
Author(s) -
Li ChiaIng,
Chen HsuanJu,
Lai HsuehChou,
Liu ChiuShong,
Lin WenYuan,
Li TsaiChung,
Lin ChengChieh
Publication year - 2014
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29321
Subject(s) - medicine , hepatocellular carcinoma , gastroenterology , hazard ratio , diabetes mellitus , type 2 diabetes , cirrhosis , proportional hazards model , cohort , incidence (geometry) , confidence interval , liver cancer , endocrinology , physics , optics
This study examined whether glycated hemoglobin A1C (HbA1C) and chronic liver diseases are associated with hepatocellular carcinoma (HCC) risk in Type 2 diabetic patients. A retrospective cohort study consisting of 51,705 patients with Type 2 diabetes aged 30 and over enrolled in the National Diabetes Care Management Program before 2004 was used in Cox proportional hazards models. HbA1C was independently associated with HCC incidence, and multivariate‐adjusted hazard ratio (HR) of HCC was 1.20 (95% confidence interval, CI: 1.02–1.41) for patients with a level of HbA1c ≥ 9% compared with patients with a level of HbA1c <7% after multivariate adjustment. We observed a significant linear trend in HCC incidence with increasing HbA1c ( p for trend = 0.02, HR = 1.07, 95% CI = 1.01–1.12 for every 1% increment in HbA1c). We observed significant HRs of HCC for patients with a level of HbA1c ≥ 9% with alcoholic liver damage, liver cirrhosis, HBV, HCV and any one of chronic liver diseases compared with patients with a level of HbA1c <9% and no counterpart comorbidity in the entire sample (HR = 8.63, 95% CI = 1.41–52.68; HR = 5.02, 95% CI = 3.10–8.12; HR = 2.53, 95% CI = 1.10–5.85; HR = 1.79, 95% CI = 1.01–3.17; and HR = 3.59, 95% CI = 2.56–5.02, respectively). Our results suggest significant joint associations of HbA1c ≥ 9% and chronic liver diseases. Lifestyle or treatment interventions such as maintaining a satisfactory glycemic control and chronic liver diseases may reduce the burden of HCC.