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. 2023 Jan 4:9:962337.
doi: 10.3389/fmed.2022.962337. eCollection 2022.

Severe hypoglycemia in patients with liver cirrhosis and type 2 diabetes

Fu-Shun Yen  1 , Ming-Chih Hou  2   3 , Jia-Sin Liu  4 , Chih-Cheng Hsu  4   5   6   7 , Chii-Min Hwu  2   8
Affiliations

Severe hypoglycemia in patients with liver cirrhosis and type 2 diabetes

Fu-Shun Yen et al. Front Med (Lausanne). .

Abstract

Introduction: Advanced liver disease with massive liver damage may affect the metabolism of hypoglycemic agents and increase the risk of hypoglycemia. We conduct this research to compare the risk of severe hypoglycemia between patients with type 2 diabetes, with and without compensated liver cirrhosis.

Methods: From Taiwan's National Health Insurance Research Database, we identified persons with type 2 diabetes with cirrhosis (n = 18,209) and without cirrhosis (n = 538,510) from January 1, 2000, to December 31, 2010. Cox proportional hazards models were adopted to assess risks of all-cause mortality and severe hypoglycemia.

Results: The mean follow-up period of this study was 3.7 years. The incidence rates of death during follow-up were 26.54 and 2.75 per 1,000 patient-years [aHR 7.63 (6.70-8.70)] for patients with cirrhosis and without cirrhosis, respectively. The incidence rates of severe hypoglycemia during follow-up were 0.53 and 0.14 per 1,000 patient-years [aHR 2.74 (1.52-4.92)] for patients with and without cirrhosis, respectively. The subgroup analysis of hypoglycemia risks in patients with and without cirrhosis disclosed no significant interaction for variables such as age, sex, chronic kidney disease, sulfonylurea use, number of oral antidiabetic drugs, insulin, b-blocker, and fibrate.

Conclusion: This cohort study demonstrated that patients with type 2 diabetes and compensated cirrhosis showed a higher risk of mortality and severe hypoglycemia than those without liver cirrhosis.

Keywords: all-cause mortality; chronic kidney disease; hypoglycemic agents; liver cirrhosis; sulfonylurea.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the selection of cohorts from the National Health Insurance Research Database.
FIGURE 2
FIGURE 2
The cumulative incidence of all-cause mortality between patients with cirrhosis and without cirrhosis.
FIGURE 3
FIGURE 3
The cumulative incidence of severe hypoglycemia between patients with cirrhosis and without cirrhosis.
FIGURE 4
FIGURE 4
Subgroup analysis of basic demographics, comorbidity, and medications on hypoglycemia risks in patients with type 2 diabetes with versus without liver cirrhosis.
See this image and copyright information in PMC

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