Does Type 2 Diabetes Increase the Risk of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease Patients? A Systematic Review

Abstract

Diabetes is associated with different types of cancers of which hepatocellular carcinoma (HCC) is one among them. In a study comparing patients with diabetes to those who do not have diabetes, it was evident that the risk of HCC is found to increase two-fold in diabetic than that in non-diabetic patients. It is clear that carcinogenesis is advanced due to diabetes in the liver by a variety of mechanisms. We searched PubMed and Google Scholar for articles from 2010 to 2021 that have an association between diabetes, nonalcoholic fatty liver disease (NAFLD), and HCC. For the development of HCC, diabetes is likely related at both the molecular and epidemiological levels. Both diabetes mellitus and hepatic malignancy have the worst impact on mankind socioeconomically. There is a significant relationship between diabetes and HCC independent of alcohol consumption and viral hepatitis. It is noteworthy that not only the elderly but also people of all age groups should monitor their hemoglobin A1C levels. Diet restriction and lifestyle modification can reduce the risk of complications like HCC; the increased physical activity itself can have a major influence on health and can manage comorbidities like diabetes, NAFLD, and HCC.

Keywords: diabetes; diabetes mellitus type 2; hepatocellular carcinoma (hcc); insulin resistance; non alcoholic fatty liver disease.

Figure 1. PRISMA flow chart

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Stages of liver cancer development from NAFLD to end-stage HCC

Originally done by the first author NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; HCV, hepatitis C virus; HBV, hepatitis B virus

Figure 3. Correlation between NAFLD, diabetes, and HCC

Done by the first author NAFLD: nonalcoholic fatty liver disease [15-17]