Hyperglycemia and chronic liver diseases on risk of hepatocellular carcinoma in Chinese patients with type 2 diabetes-National cohort of Taiwan Diabetes Study

This study examined whether glycated hemoglobin A1C (HbA1C) and chronic liver diseases are associated with hepatocellular carcinoma (HCC) risk in Type 2 diabetic patients. A retrospective cohort study consisting of 51,705 patients with Type 2 diabetes aged 30 and over enrolled in the National Diabetes Care Management Program before 2004 was used in Cox proportional hazards models. HbA1C was independently associated with HCC incidence, and multivariate-adjusted hazard ratio (HR) of HCC was 1.20 (95% confidence interval, CI: 1.02-1.41) for patients with a level of HbA1c9% compared with patients with a level of HbA1c <7% after multivariate adjustment. We observed a significant linear trend in HCC incidence with increasing HbA1c (p for trend=0.02, HR=1.07, 95% CI=1.01-1.12 for every 1% increment in HbA1c). We observed significant HRs of HCC for patients with a level of HbA1c9% with alcoholic liver damage, liver cirrhosis, HBV, HCV and any one of chronic liver diseases compared with patients with a level of HbA1c <9% and no counterpart comorbidity in the entire sample (HR=8.63, 95% CI=1.41-52.68; HR=5.02, 95% CI=3.10-8.12; HR=2.53, 95% CI=1.10-5.85; HR=1.79, 95% CI=1.01-3.17; and HR=3.59, 95% CI=2.56-5.02, respectively). Our results suggest significant joint associations of HbA1c9% and chronic liver diseases. Lifestyle or treatment interventions such as maintaining a satisfactory glycemic control and chronic liver diseases may reduce the burden of HCC. What's new? This is the first study to examine whether glucose control as measured with HbA1c level and chronic liver diseases are associated with hepatocellular carcinoma (HCC) in Chinese type-2 diabetic patients. A positive association was found between HbA1c level and HCC risk, with a level of HbA1c9% being a predictor of HCC risk. Furthermore, the level of HbA1c9% and chronic liver diseases were significantly jointly associated with HCC risk. HCC incidence is rapidly increasing worldwide, and lifestyle or treatment interventions to maintain a satisfactory control over glycemia and chronic liver diseases may reduce the burden of HCC.