[acb-diabetics] liver 50% in risk because of diabetes

[Patricia LaFrance-Wolf]

This article originally posted 25 June, 2010 and appeared in  

Issue 527

 

Liver at 50% Greater Risk in Diabetes

 

Although the liver is often overlooked in diabetes, even newly-diagnosed
cases carry a substantial risk of serious hepatic damage, researchers
found....

 

Advertisement 

 

Click here to find out more! frame

 

Flash movie start

Flash movie end

Click here to find out more! frame end

 

According to Gillian Booth, MD, MSc, of St. Michael's Hospital in Toronto,
in a population-based study, newly-diagnosed diabetes was associated with a
near

doubling in the rate of liver cirrhosis, liver failure, or liver transplant
compared with people in the general population who did not have diabetes.

 

After adjusting for important contributors to liver disease, the association
remained significant with a 77% increased risk for newly-diagnosed diabetes

patients (95% confidence interval 68% to 86%).

 

"The negative impact of diabetes on the retinal, renal, nervous, and
cardiovascular systems is well recognized, yet little is known about its
effect on

the liver," they wrote.

 

According to Kenneth Cusi, MD, who has been studying this condition at the
University of Texas Health Science Center in San Antonio, although much
still

remains to be discovered about the mechanisms and cause of the link between
diabetes and liver disease, nonalcoholic steatohepatitis (NASH) is almost
certainly

involved.

 

"Steatosis is known to arise in relationship to insulin resistance in
obesity, and most people with the condition do have some degree of glucose
abnormality....

The two seem to 'feed on each other'."

 

Unlike with eye disease, cardiovascular disease, and kidney disease,
guidelines for diabetes care don't recommend screening for liver disease.

 

"However, when the liver fails," Booth's group cautioned in the paper,
"there is no equivalent form of management, such as hemodialysis or retinal
photocoagulation."

 

They suggested that liver disease "may be appropriate for addition to the
list of target-organ conditions related to diabetes," with annual screening
by

means of a blood test, such as for the liver enzyme alanine
aminotransferase.

 

But the sensitivity of blood tests and even ultrasound aren't great for
identifying fatty liver disease that is the precursor to more serious liver
problems

and liver biopsy is not a feasible screening method, Cusi noted.

 

Also, it would first have to be shown that preventive measures such as
weight loss and glycemic and lipid control are effective in diabetes, as
they are

in isolated fatty liver without diabetes, the researchers said.

 

To expand evidence for the link, the researchers retrospectively examined
the administrative databases of the universal healthcare system in the
province

of Ontario from 1994 through 2006.

 

They compared 438,069 adults with newly diagnosed diabetes and an age-,
sex-, and regionally-matched control group of 2,059,708 individuals without
known

diabetes. Preexisting liver or alcohol-related disease were cause for
exclusion.

 

During a median of 6.4 years of follow-up, serious liver disease -- liver
cirrhosis, liver failure, or liver transplant -- developed in 2,463
newly-diagnosed

diabetes cases and 5,902 controls.

 

Thus, unadjusted liver disease incidence was 92% higher with diabetes (8.19
per 10,000 person-years with diabetes and 4.17 without it).

 

This difference remained significant across mutually-adjusted patient
subgroups by age, gender, urban versus rural residence, and income level.

 

Diabetes appeared to have the most pronounced link with liver and the least
with liver transplantation.

 

Hypertension and obesity didn't appear to entirely account for the
relationship with diabetes. The risk of serious liver disease in nondiabetic
individuals

with preexisting hypertension or obesity was elevated but less so than among
those with diabetes.

 

But the researchers cautioned that it is difficult to separate out the
effects of these related conditions.

 

"Although our findings and those of the U.S. study [which found elevated
chronic NASH risk in veterans with diabetes] edge forward the idea that
diabetes

may be harmful to the liver, the question remains of whether this effect
extends beyond the metabolic syndrome," they wrote.

 

Another question that remains to be answered is causality.

 

Booth's group pointed out that hepatic fat content rises in parallel with
insulin resistance and glucose dysregulation and that diabetes as a
complication

of cirrhosis typically doesn't arise until cirrhosis reaches an advanced
stage.

 

However, they noted, they couldn't rule out the pre-existence of subclinical
liver disease before study entry.

 

Practice Pearls:

list of 2 items

. Note that the retrospective study could not determine whether diabetes
caused the liver disease seen during follow-up. 

. Note that diabetes guidelines do not recommend screening for liver
disease. 

list end

 

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://www.acb.org/pipermail/acb-diabetics/attachments/20100627/185fded0/attachment.htm>