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.
Gastroenterology is the official journal of the American Gastroenterological Association, the oldest non-profit specialty medical society in the United States, with a membership of more than 13,000 physicians and researchers. Gastroenterology is the most prominent journal in the subspecialty and is in the top one percent of indexed medical journals internationally. Gastroenterology is published monthly.
GASTROENTEROLOGY