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. 2025 Aug;62(3):319-329.
doi: 10.1111/apt.70188. Epub 2025 May 8.

Diabetes Mellitus in Patients With Autoimmune Hepatitis: Frequency, Risk Factors and Effect on Outcome

Sarah Flatley  1   2 , Selena Dixon  1 , Eleanor Pilsworth  1 , Asha Dube  3 , Barbara Hoeroldt  1 , Laura Harrison  1 , Dermot Gleeson  1   2
Affiliations

Diabetes Mellitus in Patients With Autoimmune Hepatitis: Frequency, Risk Factors and Effect on Outcome

Sarah Flatley et al. Aliment Pharmacol Ther. 2025 Aug.

Abstract

Background: Treatment for autoimmune hepatitis (AIH) includes corticosteroids, which are associated with the development of diabetes mellitus (DM). Reported new-onset DM rates in patients with AIH have varied, and predisposing factors and prognostic implications are inadequately characterised.

Aim: To identify the frequency and predisposing factors for DM in AIH and its association with disease progression and mortality.

Methods: Retrospective/prospective single-centre study of 494 patients with AIH presenting 1987-2023, 466 receiving corticosteroids (454 prednisolone, 12 budesonide) and followed for (median (range) 9 (0-36) years).

Results: Forty-seven patients (10%) already had DM at AIH diagnosis. New-onset DM subsequently developed in another 59 (13%). In those receiving prednisolone, new-onset DM incidence was 8% ± 1% after 1 year and 14% ± 2% after 10 years (14- and 3-fold higher than expected population rate), and was independently associated with older age, non-Caucasian ethnicity, higher initial prednisolone dose, higher BMI at diagnosis and more weight gain after 2 years of follow-up. New-onset DM usually persisted despite stopping prednisolone. New-onset DM and DM at any time were independently associated with all-cause death/transplantation rate, along with previously established risk factors (older age, cirrhosis, lower ALT at diagnosis and failure of early ALT normalisation). New-onset DM and DM at any time were also independently associated with cirrhosis development. Similar associations of new-onset DM and DM at any time with liver-related death/transplantation were significant on univariate but not multivariate analysis.

Conclusion: New-onset DM occurred in 13% of patients with AIH, was related to older age, non-Caucasian ethnicity, higher prednisolone dose, higher BMI at diagnosis and weight gain; and was an independent predictor of all-cause death/transplantation and of cirrhosis development, underlining the need to minimise steroid burden in AIH.

Keywords: autoimmune hepatitis; cirrhosis; diabetes mellitus; liver; outcome; prevalence; risk factors.

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Conflict of interest statement

Dermot Gleeson: Invited speaker (on PSC). Dr. Falk sponsored symposium 2023; hospitality, no honorarium. The other authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Cumulative rate of new‐onset DM in relation to (a) receipt of prednisolone, (b) age (c) BMI at diagnosis and (d) initial prednisolone dose.
FIGURE 2
FIGURE 2
Mean daily prednisolone dose for patients with new‐onset DM and no DM. Total number of patients was 415. Details were not accessible regarding prednisolone dose schedule in 47 of these (11%), usually because treatment was started elsewhere. Dose difference at time 0 was significant (p = 0.036), but not at any subsequent time.
FIGURE 3
FIGURE 3
Cumulative survival curves for all‐cause and liver‐related death/transplantation.
See this image and copyright information in PMC

References

    1. Lamers M. M., van Oijen M. G., Pronk M., and Drenth J. P., “Treatment Options for Autoimmune Hepatitis: A Systematic Review of Randomized Controlled Trials,” Journal of Hepatology 53, no. 1 (2010): 191–198. - PubMed
    1. Gleeson D. and Heneghan M. A., “British Society of Gastroenterology (BSG) Guidelines for Management of Autoimmune Hepatitis,” Gut 60, no. 12 (2011): 1611–1629. - PubMed
    1. Dyson J. K., Wong L. L., Bigirumurame T., et al., “Inequity of Care Provision and Outcome Disparity in Autoimmune Hepatitis in the United Kingdom,” Alimentary Pharmacology & Therapeutics 48, no. 9 (2018): 951–960. - PMC - PubMed
    1. Gurwitz J. H., Bohn R. L., Glynn R. J., Monane M., Mogun H., and Avorn J., “Glucocorticoids and the Risk for Initiation of Hypoglycemic Therapy,” Archives of Internal Medicine 154, no. 1 (1994): 97–101. - PubMed
    1. Gulliford M. C., Charlton J., and Latinovic R., “Risk of Diabetes Associated With Prescribed Glucocorticoids in a Large Population,” Diabetes Care 29, no. 12 (2006): 2728–2729. - PubMed

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