In the largest study of its kind, researchers have shown that diabetes can cause chronic liver disease and cancer of the liver. The prospective cohort study was comprised of 173,643 patients with diabetes and 650,620 patients without diabetes who were discharged from VA hospitals between 1985 and 1990. These patients were tracked through 2000. Most were men (98 percent). The majority (99.5 percent) of diabetic patients had type II diabetes mellitus. Among diabetic patients, the incidence of chronic liver disease and cancer of the liver was about twice the incidence that of patients without diabetes.From the American Gastroenterological Association :Diabetes doubles risk of liver disease and liver cancer
Bethesda, Maryland (February 2004) ? In the largest study of its kind, researchers have shown that diabetes can cause chronic liver disease and cancer of the liver. Researchers from the Department of Veterans Affairs (VA) and the National Institutes of Health report their findings in the February issue of Gastroenterology, the journal of the American Gastroenterological Association.
The prospective cohort study was comprised of 173,643 patients with diabetes and 650,620 patients without diabetes who were discharged from VA hospitals between 1985 and 1990. These patients were tracked through 2000. Most were men (98 percent). The majority (99.5 percent) of diabetic patients had type II diabetes mellitus. Among diabetic patients, the incidence of chronic liver disease and cancer of the liver was about twice the incidence that of patients without diabetes.
A link between diabetes and liver disease was previously known; it was unknown whether diabetes caused liver disease or vice versa. Liver disease associated with diabetes is usually insidious, asymptomatic and goes undetected until a severe condition, such as liver cancer, occurs.
“Because of the significantly increased risk of developing liver disease, we recommend regular testing of liver enzymes for patients with diabetes,” said study author Hashem El-Serag, MD, MPH, from the Houston VA Medical Center. “For patients with diabetes who receive oral medications, there has been a concern about toxicity in the liver ? more reason to test liver enzymes early on and then periodically thereafter.”
The risk for developing liver disease and liver cancer is highest among patients with long-standing (10+ years since diagnosis) diabetes. The increased risk is independent of alcoholic liver disease, viral hepatitis and demographic features. The public health significance of these findings is potentially large as it is estimated that 18.2 million people in the United States have diabetes.
Asian Indian men are at increased risk to develop type 2 diabetes mellitus because of chronic liver disease rather than obesity, Yale School of Medicine researchers report in the November 13 issue of the Proceedings of the National Academy of Sciences.
Diabetes mellitus is strongly associated with obesity in most, but not all, ethnic groups and the study was intended to examine ethnic differences in disease susceptibility. The risk statement is based on the researchers’ finding that insulin resistance associated with non-alcoholic fatty liver disease is three to four times more prevalent in healthy, lean, Asian Indian men than in lean men of other ethnic groups.
“The worldwide prevalence of type 2 diabetes mellitus is expected to double within the next two decades with the greatest increase occurring in Asia and the Indian subcontinent, where it will affect 130 million individuals,” said the principal investigator, Gerald Shulman, an investigator of the Howard Hughes Medical Institute and professor of internal medicine and cellular and molecular physiology. “This might explain why Asian Indians tend to develop type 2 diabetes mellitus without the same degree of obesity found in most other ethnic groups.”
Interestingly, the insulin resistance was not found in Asian Indian women, which might indicate protective effects of estrogen on this process, the researchers said.
In the study an oral glucose tolerance test to assess whole body insulin sensitivity and magnetic resonance imaging measured liver fat content of 482 young, lean, healthy, sedentary, non-smoking Eastern Asians, Asian Indians, Blacks, Caucasians, and Hispanics. The prevalence of insulin resistance was about three-to-four-fold higher in the Asian Indian men compared to other ethnic groups and was associated with an approximately two-fold increase in hepatic triglyceride content.
Shulman said that based on his previous studies it is likely that the increased liver fat content was playing an important role in causing the insulin resistance. He also said that these data have potentially important implications for the prevention and treatment of type 2 diabetes in these individuals.