Diabetes is not an independent risk factor for hepatocellular carcinoma
Journal
Diabetes/Metabolism Research and Reviews
Journal Volume
29
Journal Issue
7
Pages
515-524
Date Issued
2013
Author(s)
Abstract
Background: It is controversial whether diabetes is a risk factor for hepatocellular carcinoma (HCC) in countries with high prevalence of viral hepatitis such as Taiwan. Methods: From the Taiwanese National Health Insurance, 1000000 insurants were randomly selected for the study. Among them, 494080 men and 502841 women without HCC were followed from 2003 until 2005. Relative risks were estimated taking into account alcohol-related diagnoses, chronic liver disease, potential HCC detection examinations and other covariates. Results: The diabetes patients were more likely to receive examinations of abdominal sonography, HBsAg, anti-HCV and alpha-fetoprotein. Multivariable-adjusted relative risk (95% confidence interval) was not significant for diabetes as a risk factor for HCC in either men or women: 0.932 (0.788-1.101) for men and 1.158 (0.968-1.386) for women. While comparing diabetes duration <1, 1-3 and ?3years to non-diabetes individuals, the respective relative risks were 1.043 (0.751-1.448), 0.945 (0.738-1.209) and 0.901 (0.744-1.091) for men; and were 0.950 (0.610-1.480), 1.169 (0.884-1.546) and 1.189 (0.974-1.452) for women. For both sexes, age, alcohol-related diagnoses, chronic liver disease and potential detection bias were significantly associated with higher risk, but dyslipidemia and stroke a lower risk. In addition, chronic obstructive pulmonary disease was associated with a lower risk and sulfonylurea a higher risk in men. Models that did not consider alcohol-related diagnoses, chronic liver disease and potential detection bias would result in spurious association between diabetes and HCC. Conclusions: Diabetes is not an independent risk factor for HCC after considering the effects of alcohol-related diagnoses, chronic liver disease and potential detection bias. ? 2013 John Wiley & Sons, Ltd.
SDGs
Other Subjects
acarbose; alcohol; alpha fetoprotein; hepatitis B surface antigen; insulin; metformin; pioglitazone; rosiglitazone; sulfonylurea; virus antibody; alcohol liver cirrhosis; alcohol liver disease; alcoholism; article; cancer diagnosis; cancer patient; cerebrovascular accident; chronic liver disease; chronic obstructive lung disease; controlled study; diabetes mellitus; diabetic patient; disease association; disease duration; dyslipidemia; echography; female; Hepatitis C virus; high risk patient; human; insulin treatment; liver cell carcinoma; major clinical study; male; national health insurance; patient selection; prevalence; priority journal; risk factor; Taiwan; detection bias; diabetes; hepatocellular carcinoma; incidence; Taiwan; Adult; Carcinoma, Hepatocellular; Diabetes Complications; Diabetes Mellitus; Female; Follow-Up Studies; Humans; Incidence; Liver Neoplasms; Male; Risk Factors; Taiwan
Type
journal article