chronic hepatitis B infection and diabetes mellitus: a double liver trouble?

BacKGrOUnd: concomitant diabetes mellitus (dM) is commonly recognized in patients with chronic hepatitis B (cHB) infection, although its impact on liver-related outcomes remains controversial. We aimed to evaluate the effect of dM on the course, management and outcome of patients with cHB. MeTHOdS: We performed a large retrospective cohort study utilizing the Leumit-Health-Service (LHS) database. We reviewed electronic reports of 692106 LHS members from different ethnicities and districts in israel from 2000-2019 and included patients with cHB diagnosis based on icd-9-cM codes and supportive serology results. These were divided into two cohorts of patients with cHB and dM (cHd-dM) (n.=252) and those with cHB without dM (n.=964). clinical parameters, treatment figures and patients’ outcomes were compared and multiple regression models and Cox regression analysis were performed to investigate the association between dM and cirrhosis/Hcc risk in cHB patients. RESULTS: CHD-DM patients were significantly older (49.2±10.9 vs. 37.9±14, P<0.001), and had higher rates of obesity (BMi>30) and naFLd (47.2% vs. 23.1%, and 27% vs. 12.6%, P<0.001, respectively). Both groups had a predominance of inactive carrier (HBeAg negative infection) state, but the HBeAg seroconversion rate was significantly lower in the cHB-dM group (25% vs. 45.7%; P<0.01). Multivariable Cox regression analysis showed that DM was independently associated with increased cirrhosis risk (HR 2.63; P=0.002). Older age, advanced fibrosis and DM were associated with HCC, but DM did not reach significance (HR 1.4; P=0.12) possibly due to the small number of HCC cases. CONCLUSIONS: Concomitant DM in CHB patients was significantly and independently associated with cirrhosis and possibly with increased risk of Hcc.