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Association of exogenous insulin or sulphonylurea treatment with an increased incidence of hepatoma in patients with hepatitis C virus infection
Author(s) -
Kawaguchi Takumi,
Taniguchi Eitaro,
Morita Yasuyo,
Shirachi Miki,
Tateishi Ikuo,
Nagata Eisuke,
Sata Michio
Publication year - 2010
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2009.02191.x
Subject(s) - medicine , incidence (geometry) , virology , insulin , hepatitis c virus , diabetes mellitus , hepatitis c , gastroenterology , virus , endocrinology , physics , optics
Background: Diabetes mellitus is frequently seen in hepatitis C patients and is often treated with antidiabetic agents that increase serum insulin levels. Because insulin is a growth‐promoting hormone, antidiabetic agents could pose a risk for hepatocellular carcinoma (HCC). Aim: The aim of this study was to investigate an association between antidiabetic therapies and the incidence of HCC in hepatitis C patients with diabetes mellitus. Methods: A nested case–control study was conducted. Participants were recruited from a cohort study, in which patients with hepatitis C were consecutively registered. Participants were assigned to an HCC group ( n =138) or a non‐HCC group ( n =103). To identify independent factors, variables including use of antidiabetic agents were analysed by logistic regression analysis. Results: Besides ageing, being male, cirrhosis and hypoalbuminaemia, use of exogenous insulin and a second‐generation sulphonylurea were significant independent factors associated with an incidence of HCC [odds ratio (OR) 2.969, 95% confidence interval (CI) 1.293–6.819, P <0.0103 and OR 6.831, 95% CI 1.954–23.881, P <0.0026 respectively). In stratified analyses, the impact of these antidiabetic agents was more evident in patients who were non‐cirrhotic than in those who were cirrhotic. Conclusions: Exogenous insulin and a second‐generation sulphonylurea were independent variables associated with an incidence of HCC in hepatitis C patients with diabetes mellitus. This association was evident in patients who were non‐cirrhotic. To verify a causal relationship between these antidiabetic agents and the development of HCC, a prospective cohort study is required.