Cardiovascular disease, cancer, and mortality among people with type 2 diabetes and alcoholic or nonalcoholic fatty liver disease hospital admission

Scottish Diabetes Research Network Epidemiology Group

Research output: Contribution to journalArticlepeer-review

51 Citations (Scopus)

Abstract

OBJECTIVE To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people aged 40–89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and ICD-10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors. RESULTS A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non- HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality. CONCLUSIONS Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.

Original languageEnglish
Pages (from-to)341-347
Number of pages7
JournalDiabetes care
Volume41
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by funding from the Scottish Government through the Scottish Diabetes Group. The Scottish Diabetes ResearchNetworkissupportedbyNHSResearch Scotland, a partnership of Scottish NHS Boards and the Chief Scientist Office of the Scottish Government.N.S.receivedEuropeanFederation of Pharmaceutical Industries and Associations Innovative Medicines Initiative Joint Undertaking grant number 115372, which partially supports his contribution to this article. C.D.B. is supported in part by the Southampton National Institute for Health Research Biomedical Research Centre. Data linkage was funded by the Scottish Government through the Scottish Diabetes Group.

Funding Information:
of Pharmaceutical Industries and Associations Innovative Medicines Initiative Joint Undertaking grant number 115372, which partially supports his contribution to this article. C.D.B. is supported in part by the Southampton National Institute for Health Research Biomedical Research Centre. Data linkage was funded by the Scottish Government through the Scottish Diabetes Group. Duality of Interest. No potential conflicts of interest relevant to this article were reported. Author Contributions. S.H.W., J.J.W., J.R.M., D.A.M., H.M.C., B.F., S.M., R.M., S.H.R., N.S., and C.D.B. contributed to the data interpretation, critically reviewed the manuscript for important intellectual content, and approved the final version. S.H.W., J.J.W., and C.D.B. wrote the first draft of the manuscript. S.H.W., J.J.W., J.R.M., and C.D.B. designed the study and the analysis plan; data were acquired as part of routine clinical care. S.H.W. and C.D.B performed the literature search. J.J.W. prepared and analyzed the data and prepared the figures. H.M.C., B.F., and S.M. contributed to the generation of data. S.H.W. is the guarantor of this work and, as such, had full access to all the data in thestudyandtakesresponsibilityfortheintegrityof the data and the accuracy of the data analysis. Prior Presentation. Parts of this study were presented at the Diabetes UK Professional Conference, Manchester, U.K., 8–10 March 2017, and the 53rd Annual Meeting of the European Association for the Study of Diabetes, Lisbon, Portugal, 11–15 September 2017.

Funding Information:
health care staff, people with diabetes, the SCI-DC Steering Group, the Scottish Diabetes Group, the Scottish Diabetes Survey Group, clinical network managers, and staff of each NHS Board for providing data and setting up, maintaining, and overseeing the SCI-DC. Funding. This work was supported by funding from the Scottish Government through the Scottish Diabetes Group. The Scottish Diabetes Research Network is supported by NHS Research Scotland, a partnership of Scottish NHS Boards and the Chief Scientist Office of the Scottish Government.N.S.receivedEuropeanFederation

Publisher Copyright:
© 2017 by the American Diabetes Association.

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