2019 Apr 19. pii: S1542-3565(19)30428-8. doi: 10.1016/j.cgh.2019.04.038. [Epub ahead of print]

Risk Factors for Severe Liver Disease in Patients With Type 2 Diabetes.

Björkström K1Franzen S2Eliasson B3Miftaraj M2Gudbjörnsdottir S3Trolle-Lagerros Y4Svensson AM3Hagström H5.



Type 2 diabetes is a risk factor for development of cirrhosis and hepatocellular carcinoma. However, risk factor that identify persons with the highest risk for these outcomes are missing from unselected, population-based cohorts.


The National Diabetes Register contains data on about 90% of persons in Sweden with type 2 diabetes. In this cohort study, persons with type 2 diabetes listed in the National Diabetes Register were compared with 5 individuals from the general population (controls), matched for age, sex, and county. In total, 406 770 persons with type 2 diabetes and 2 033 850 controls were included and followed for 21 596 934 person-years. We used population-based registers to determine the incidence of severe liver disease, defined as a diagnosis of hepatocellular carcinoma, cirrhosis, decompensation, liver failure and/or death due to liver disease during follow up. Cox regression was performed to estimate the risk of severe liver disease and to examine risk factors in persons with type 2 diabetes.


Risk for severe liver disease was increased in patients with type 2 diabetes compared to controls (hazard ratio, 2.28; 95% CI, 2.21-2.36). '

Risk factors associated with severe liver disease in persons with type 2 diabetes were higher age, male sex, hypertension, higher body mass index, lower glomerular filtration rate, microalbuminuria, and smoking.

Statins were associated with a decreased risk of severe liver disease.


Persons with type 2 diabetes have an increased risk for severe liver disease. Knowledge of risk factors can be helpful in identifying persons with type 2 diabetes who have a high risk for severe liver disease.

Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.


HCC risk; NAFLD; T2DM; obesity

PMID: 31009793 DOI: 10.1016/j.cgh.2019.04.038


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