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Four-Fold Increase for Chronic Liver Disease for Type 1’s

Nov 21, 2012

Patients with type 1 diabetes displayed a greater risk for developing chronic liver disease, including a fourfold prevalence for cirrhosis, compared with the general population….

Among a longitudinal cohort of 4,644 patients with type 1 diabetes, researchers in the United Kingdom used a computer database to identify 57 (1.2%) who had undergone 82 liver biopsies. Each was gender-matched with insulin-treated (n=57) and noninsulin-treated type 2 diabetes patients (n=57). Both type 2 diabetes groups also had undergone liver biopsy.

In the type 2 diabetes cohort (n=9,571), 270 patients (2.8%) underwent 301 liver biopsies. Compared with both type 2 diabetes arms, type 1 diabetes patients had lower occurrence of nonalcoholic fatty liver disease (OR=0.35; 95% CI, 0.15-0.82), but they showed higher diagnoses of glycogenosis (OR=9.1; 95% CI, 1.10-75.75).

Researchers said 14 type 1 diabetes patients were diagnosed with cirrhosis during follow-up, which equated to a prevalence of at least 301.5 (170-520) per 100,000 individuals compared with an estimated cirrhosis prevalence of 76.3/100,000 (OR=3.96; 95% CI, 2.24-7.01) in the general UK population. Type 1 diabetes patients displayed a lower diagnosis rate of cirrhosis than type 2 diabetes patients using insulin (OR=0.46; 95% CI, 0.23-0.91) and type 2 nonusers (OR=0.42; 95% CI, 0.21-0.84).

Twenty-two type 1 diabetes patients (38.6%) who had liver biopsy died during follow-up, which equated to an estimated crude death rate of 6,539/100,000 person-years, compared with an anticipated 1,878/100,000 person-years based on the National Diabetes Mortality Analysis 2007-08.

"A patient with type 1 diabetes is at a significant risk of developing liver disease, and I don’t think that was something that was previously realized," David J. Harman, PhD, hepatology research fellow at Nottingham Digestive Diseases Centre Biomedical Research Unit in England, said, adding that, "Prospective cohorts are needed to confirm this data and for new algorithms to develop type 1 diabetes. But I think this is the first step in demonstrating that they’re at substantial risk of liver disease as well as their type 2 diabetes colleagues."

Harman DJ. P1467: Prevalence and natural history of histologically proven chronic liver disease in a longitudinal cohort of patients with type 1 diabetes. Presented at: The Liver Meeting 2012; Nov. 9-13, Boston