In light of the high variability in the literature on the burden of liver disease in relation to diabetes (DM), this study compared the incidence and risk of liver disease between patients with and without DM in a large population-based cohort. The study utilized the computerized database of a nationally representative payer-provider health fund in Israel. All members without cirrhosis, cancer, viral hepatitis or excess alcohol intake were followed from 2000 to 2017. Liver disease: Cirrhosis, liver transplant and hepatocellular carcinoma (HCC), were detected by coded diagnoses, procedures, and the national cancer registry. DM was defined by a previously validated registry. Age specific incidence density rates were calculated based on person years under observation. Risks of liver transplant, HCC and all-cause mortality in the cirrhotic diabetes patients were described using cox proportional hazards multivariate regression. The cohort included 1,083,4subjects with a mean follow-up of 15.1 years (SD=4.2), 2% with DM at index. A total of 2,511 incident cases of liver complications were observed. Higher incidence rates of cirrhosis were observed in patients with DM at index as compared with DM-free with rate ratios of 7.5 (95% CI: 6.5-8.7), 4.1 (3.8-4.4) and 2.3 (2.2-2.5) among patients aged <40, 40-60 and >60 years old respectively. DM was also associated with higher incidence of HCC (rate ratio 3.6 (95% CI: 3.2-4.1) and 1.7 (1.6-1.8) among ages 40-60 and >60 years old respectively) and liver transplant (rate ratio of 4.5 (3.3-6.2) and 1.6 (1.1-2.2) among ages 40-60 and >60 years old respectively). Among cirrhotic patients (n=1,527), those with DM had an adjusted HR=2.3 (95% CI: 1.2-4.5) for developing HCC, a HR=2.2 (0.9-5.3) for undergoing a liver transplant and a HR of 1.8 (1.5-2.3) for all-cause mortality as compared with DM-free, after controlling for age, BMI, sex and smoking. Diabetes is associated with higher incidence rates and higher risk of liver complications compared to those without diabetes.


I. Goldshtein: None. G. Fernandes: Employee; Self; Merck & Co., Inc.. Employee; Spouse/Partner; Janssen Research & Development. Stock/Shareholder; Self; Merck & Co., Inc.. Stock/Shareholder; Spouse/Partner; Janssen Research & Development. A. Karasik: Stock/Shareholder; Self; Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca. Research Support; Self; AstraZeneca. Consultant; Self; Boehringer Ingelheim GmbH. Advisory Panel; Self; Merck & Co., Inc., GlucoMe. S. Rajpathak: Employee; Self; Merck & Co., Inc.. G. Chodick: None.

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