Diabetes Thought to Increase Risk for Hepatic Cancer

A retroactive study presented at the 2015 Annual Meeting for the American College of Gastroenterology (ACG) suggests that diabetes increases the risk for hepatocellular carcinoma. Hepatocellular carcinoma is the most common form of liver cancer. The disease generally occurs secondary to hepatitis C infection or in cirrhosis from other causes.

The study authors used data from MarketScan, which is a database for insurance claims of all kinds. They found 7,473 patients with hepatocellular carcinoma. The authors also included 22,110 controls matched for comorbidities, age, sex, and gender, leading to a 1-to-3 ratio of subjects to controls for 99% of the case subjects. The patients included in the case group had hepatocellular carcinoma with hepatitis C with DM, without DM, and DM alone. The study also looked at the impact of metabolic syndrome, hypertension, and dyslipidemia.

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Diabetes and Fatty Liver Associated with Further Liver Problems--- Adding liver fibrosis to the long list of diabetic complications under consideration...

A recent study published in Hepatology evaluated various risk factors for liver fibrosis in a Dutch population. The call for concern is the prevalence of liver fibrosis in a patient population with low prevalence of hepatitis—the usual suspect of causation.

Some links have shown non-alcoholic liver disease has a connection to liver fibrosis. Certainly, identifying modifiable risk factors and their impact in developing liver problems can be important to targeting change.

The prospective cohort study was conducted over two years in Rotterdam on 3,041 patients, 45 years or older. Abdominal ultrasounds were used to scan their livers and evaluate liver stiffness to characterize potential fibrosis. Further collections of blood, anthropometric measures, medical history, demographics, drug use, alcohol consumption, smoking history and comorbidities were evaluated.

Just over one-third (35.5%) of the patients had the presence of fatty liver and 5.6% of the patients had a liver stiffness over 8 kPa or clinically relevant for liver fibrosis. Not surprisingly, having the presence of positive surface antigens for hepatitis B or C resulted in a five-fold increased chance in also having liver fibrosis

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The Five: Diabetes —Alan Franciscus, Editor-in-Chief

If you notice, I did not title this article HCV and diabetes.  That is because new studies have not found a direct link between hepatitis C and diabetes—that is type 2 Diabetes mellitus.  However, it is still being studied, and it keeps coming up so the complete story may not be over.   Regardless, it is an important health issue facing people living with hepatitis C especially those who are considered part of the ‘Baby Boomer’ generation.  This month’s Five is about diabetes and how it relates to people with hepatitis C and why it is important to be tested for it, how to treat it and how it may improve the chances of being approved for HCV treatment. 

Diabetes affects approximately 40 million Americans. 

1. At-Risk Populations:  People who are more likely to develop diabetes include people 45 years old or older, being overweight or obese, having a parent, brother or sister with diabetes, having a genetic disposition to developing diabetes.  Certain races and ethnicities such as African Americans, Hispanics, Alaskan Natives, American Indians, Asian Americans, Native Hawaiians or Pacific Islanders are more prone to having diabetes.

2. Symptoms:  The most common symptoms of diabetes include increased thirst and hunger or appetite, dry mouth, frequent urination (peeing), fatigue (feeling tired), unexplained weight loss—even when eating more food.  In extreme cases, people may experience loss of consciousness.

3. Complications:  Over time, left untreated or uncontrolled diabetes can lead to very serious complications including mental confusion, blurred vision, sores or wounds that are slow to heal or don’t heal, sexual problems, heart and kidney disease, blindness, peripheral neuropathy, amputation, and death.

4. Treatment:  Diabetes can be treated and controlled with diet, exercise, and medications.  It is important to be monitored regularly.

5. HCV Treatment:  Many insurance companies and state Medicaid programs are restricting HCV treatment to those with severe fibrosis and cirrhosis.   There are other conditions that may increase the chances of being approved for HCV treatment—Type 2 Diabetes mellitus is one of the conditions that may increase the likelihood of being approved for treatment.  (See: AASLD-ISDA Recommendations for Testing, Managing, and Treating Hepatitis C 2014: When and in Whom to Initiate Treatment).  Talk to your medical provider to find out if you should be tested for diabetes.  If you have diabetes—check with you medical provider about HCV treatment.

The Bottom Line:  Diabetes is a serious disease that has many consequences.  The United States Preventive Services Task Force (USPSTF) now recommends testing adults for diabetes who have high blood pressure (greater than 135/80 mm Hg).  The USPSTF is currently in the process of updating their guidelines to include screening adults:

“Having factors that increase the chances of developing high blood sugar or diabetes, such as being 45 or older, being overweight or obese, or having a close relative with diabetes.”

The updated guidelines should be released in the coming months.


http://hcvadvocate.org/news/newsLetter/2015/advocate0315_mid.html#3