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Meta-Analysis
. 2023 Nov;43(11):2479-2491.
doi: 10.1111/liv.15720. Epub 2023 Sep 26.

Autoimmune liver diseases and diabetes: A propensity score matched analysis and a proportional meta-analysis

Anne-Sofie H Jensen  1   2   3 , Marie Winther-Sørensen  1   3 , Johan Burisch  2 , Annika Bergquist  4   5 , Henriette Ytting  2   6 , Lise L Gluud  2   6 , Nicolai J Wewer Albrechtsen  1   3
Affiliations
Meta-Analysis

Autoimmune liver diseases and diabetes: A propensity score matched analysis and a proportional meta-analysis

Anne-Sofie H Jensen et al. Liver Int. 2023 Nov.

Abstract

Background and aims: Patients with some chronic liver diseases have increased risk of diabetes. Whether this is also the case for patients with autoimmune liver diseases is unknown. The study aimed to calculate risk and worldwide prevalence of diabetes in patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).

Methods: We performed a case-control study using data from the United Kingdom Biobank (UKB) and compared frequency of type 1 diabetes (T1D) and type 2 diabetes (T2D) in AIH and PBC with age-, sex-, BMI- and ethnicity-matched controls. Next, we performed a systematic review and proportional meta-analysis searching PubMed, Embase, Cochrane Library and Web of Science (inception to 1 May 2022 [AIH]; 20 August 2022 [PBC]; 11 November 2022 [PSC]). The pooled prevalence of diabetes was calculated using an inverse method random effects model.

Results: Three hundred twenty-eight AIH patients and 345 PBC patients were identified in UKB and risk of T1D and T2D significantly increased compared with matched controls. Our systematic search identified 6914 records including the UKB study. Of these, 77 studies were eligible for inclusion comprising 36 467, 39 924 and 4877 individuals with AIH, PBC and PSC, respectively. The pooled prevalence of T1D was 3.8% (2.6%-5.7%), 1.7% (0.9%-3.1%), 3.1% (1.9%-4.8%) and of T2D 14.8% (11.1%-19.5%), 18.1% (14.6%-22.2%), 6.3% (2.8%-13.3%) in patients with AIH, PBC and PSC, respectively.

Conclusions: Patients with autoimmune liver diseases have increased risk of diabetes. Increased awareness of diabetes risk in patients with autoimmune liver diseases is warranted.

Keywords: UK Biobank; autoimmune hepatitis; glucose; overlap syndrome; primary biliary cholangitis; primary sclerosing cholangitis.

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References

REFERENCES

    1. UK Biobank ethical approval [Internet]. Accessed August 11, 2023. https://www.ukbiobank.ac.uk/learn-more-about-uk-biobank/about-us/ethics
    1. Lohse AW, Chazouillères O, Dalekos G, et al. EASL clinical practice guidelines: autoimmune hepatitis. J Hepatol. 2015;63:971-1004.
    1. Hirschfield GM, Beuers U, Corpechot C, et al. EASL clinical practice guidelines: the diagnosis and management of patients with primary biliary cholangitis. J Hepatol. 2017;67:145-172.
    1. Chapman MH, Thorburn D, Hirschfield GM, et al. British Society of Gastroenterology and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis. Gut. 2019;68:1356-1378.
    1. Petersen MC, Vatner DF, Shulman GI. Regulation of hepatic glucose metabolism in health and disease. Nat Rev Endocrinol. 2017;13:572-587.

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