Is insulin the preferred treatment in persons with type 2 diabetes and liver cirrhosis?

BMC Gastroenterology

James Cheng-Chung Wei¹  Fu-Shun Yen²  Ming-Chih Hou³  Chii-Min Hwu⁴  Chih-Cheng Hsu⁵  Lu-Ting Chiu⁶  Jung-Nien Lai⁷ 

[1] Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, 40201, Taichung City, Taiwan;Institute of Medicine, Chung Shan Medical University, 40201, Taichung City, Taiwan;Graduate Institute of Integrated Medicine, China Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, 40201, Taichung City, Taiwan;Dr. Yen’s Clinic, No. 15, Shanying Road, Gueishan District, 33354, Taoyuan, Taiwan;Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Linong Street, 11221, Taipei, Taiwan;Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, 11217, Taipei, Taiwan;Faculty of Medicine, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Linong Street, 11221, Taipei, Taiwan;Section of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, 11217, Taipei, Taiwan;Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, 35053, Zhunan, Miaoli County, Taiwan;Department of Health Services Administration, China Medical University, No. 91, Hsueh-Shih Road, 40402, Taichung, Taiwan;Department of Family Medicine, Min-Sheng General Hospital, 168 ChingKuo Road, 33044, Taoyuan, Taiwan;Management Office for Health Data, China Medical University Hospital, 3F., No. 373-2, Jianxing Road, 40459, Taichung, Taiwan;College of Medicine, China Medical University, No. 110, Sec. 1, Jianguo N. Rd., South District, 40201, Taichung City, Taiwan;School of Chinese Medicine, College of Chinese Medicine, China Medical University, No. 91, Hsueh-Shih Road, 40402, Taichung, Taiwan;Department of Chinese Medicine, China Medical University Hospital, 3F., No. 373-2, Jianxing Road, 40459, Taichung, Taiwan;

关键词: All-cause mortality;    Hepatocellular carcinoma;    Hepatic failure;    Decompensated cirrhosis;    Hypoglycemia;   

DOI  :  10.1186/s12876-021-01773-x

来源: Springer

【 摘 要 】

BackgroundInsulin is highly recommended for diabetes management in persons with liver cirrhosis. However, few studies have evaluated its long-term effects in these persons. We conducted this study to compare the risks of mortality, liver-related complications, and cardiovascular events in persons with type 2 diabetes mellitus (T2DM) and compensated liver cirrhosis.MethodsFrom January 1, 2000, to December 31, 2012, we selected 2047 insulin users and 4094 propensity score-matched nonusers from Taiwan’s National Health Insurance Research Database. Cox proportional hazard models were used to assess the risks of outcomes.ResultsThe mean follow-up time was 5.84 years. The death rate during the follow-up period was 5.28 and 4.07 per 100 person-years for insulin users and nonusers, respectively. In insulin users, the hazard ratios and 95% confidence intervals (CIs) of all-cause mortality, hepatocellular carcinoma, decompensated cirrhosis, hepatic failure, major cardiovascular events, and hypoglycemia were 1.31 (1.18–1.45), 1.18 (1.05–1.34), 1.53 (1.35–1.72), 1.26 (1.42–1.86), 1.41 (1.23–1.62), and 3.33 (2.45–4.53), respectively.ConclusionsThis retrospective cohort study indicated that among persons with T2DM and compensated liver cirrhosis, insulin users were associated with higher risks of death, liver-related complications, cardiovascular events, and hypoglycemia compared with insulin nonusers.

【 授权许可】

CC BY