Daily Dose: T2D Raises Risk for Hepatic Decompensation, Hepatocellular Carcinoma in Patients with NAFLD

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On July 11, 2023, we reported on a study published in the Lancet Gastroenterology and Hepatology that examined the risk of hepatic decompensation in patients with nonalcoholic fatty liver disease (NAFLD) and without type 2 diabetes (T2D).

The study

The meta-analysis comprised individual participant level data from 6 international cohorts whose participants had magnetic resonance elastography (MRE) between February 27, 2007, and June 4, 2021. In addition to liver fibrosis identified by MRE, eligible studies included longitudinal assessment for hepatic decompensation and death and participants were adults aged ≥18 years with NAFLD who had data supporting a diagnosis of T2D at baseline.

The initial cohort numbered 2016; 53.5% were women, mean age was 57.8 years, and mean body mass index was 31.3 kg/m². After excluding participants who had hepatic decompensation at baseline and those without longitudinal data, there were 1737 participants in the group for final analysis, of whom 602 had T2D at baseline.

The findings

Over a median follow-up of 2.8 years, 105 participants (11.8%) developed hepatic decompensation or died without hepatic decompensation. The risk of hepatic decompensation (sHR, 95% CI) was significantly higher among participants with T2D vs no T2D at 1, 3, and 5 years.

The analysis for HCC included 1802 participants 639 with (T2D). Over a median follow-up of 2.9 years, 22 participants (18 with baseline T2D, 4 without), developed incident HCC. Similar to the risk of hepatic decompensation, risk of incident HCC at 1, 3, and 5 years was significantly greater among participants with T2D vs without T2D.

A note from authors

"The higher risk of hepatic decompensation and HCC in people with type 2 diabetes should be considered when designing clinical trials in NAFLD. These data serve as a call to action to prevent type 2 diabetes and reduce the growing burden of NAFLD and NAFLD-related hepatocellular carcinoma.”

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