Issue 115 Item 7 Diabetes Increases The Risk of Liver Failure- Another Complicat

According to findings from a large Veterans Affairs cohort study, diabetic patients are at an increased risk of developing acute liver failure. Drs. El-Serag from the Houston Department of Veterans Affairs Medical Center and Dr. Everhart from the National Institute of Diabetes and Digestive and Kidney Diseases identified all the patients in the VA database who were discharged with a diagnosis of diabetes from 1985 to 1990. They compared these patients to a randomly selected cohort of nondiabetic patients. The final study cohort included 173,643 diabetic patients and 650,620 nondiabetic patients who were followed through 2000, according to the report in the June issue of Gastroenterology.

Among diabetic patients, the cumulative risk of acute liver failure was significantly higher compared with nondiabetic patients (incidence rate 2.31 per 10,000 person years versus 1.44 per 10,000 person years, p<0.0001), Drs. El-Serag and Everhart found.

Analysis that controlled for comorbidity, age, sex, ethnicity, and period of military service found that diabetes was associated with a relative risk of 1.44 for developing acute liver failure (p<0.0001).

This association remained significant after excluding patients who developed viral hepatitis during followup and those with acute liver failure after troglitazone was introduced (relative risk 1.40, p<0.0001).

Drs. El-Serag and Everhart advise that "periodic monitoring of liver enzymes and caution in the use of potentially hepatotoxic drugs may be warranted in patients with diabetes." Gastroenterology 2002;122:1822-1828.