Potential Protective Effect of Hepatitis B Immunity Against Diabetes Mellitus: A Retrospective Propensity-Matched Cohort Study

Nhu Quynh Phan^{1

2}, Shih-Jung Lin³, Ngoc Hoang Le⁴, Van Thuan Nguyen¹, Tan Ha Mai⁵, Jin-Hua Chen^{6

7

8}, Min-Huei Hsu⁶, Dinh Khanh Hoang^{1

9}, Phung Manh Thang², Ya-Li Huang¹⁰, Chiehfeng Chen^{10

11

12

13}

Affiliations

¹ International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
² Department of Infection Control, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam.
³ School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
⁴ Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
⁵ Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan.
⁶ Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 11031, Taiwan.
⁷ Research Center of Biostatistics, College of Management, Taipei Medical University, Taipei 11031, Taiwan.
⁸ Biostatistics Center, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.
⁹ Department of Histopathology, Hai Phong University of Medicine and Pharmacy, Hai Phong 180000, Vietnam.
¹⁰ Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
¹¹ Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan.
¹² Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.
¹³ Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.

PMID: 40647610
PMCID: PMC12248427
DOI: 10.3390/diagnostics15131610

Potential Protective Effect of Hepatitis B Immunity Against Diabetes Mellitus: A Retrospective Propensity-Matched Cohort Study

Nhu Quynh Phan et al. Diagnostics (Basel). 2025.

. 2025 Jun 25;15(13):1610.

doi: 10.3390/diagnostics15131610.

Authors

Affiliations

¹ International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
² Department of Infection Control, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam.
³ School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
⁴ Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan.
⁵ Department of Computer Science and Information Engineering, National Taiwan University, Taipei 10617, Taiwan.
⁶ Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei 11031, Taiwan.
⁷ Research Center of Biostatistics, College of Management, Taipei Medical University, Taipei 11031, Taiwan.
⁸ Biostatistics Center, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.
⁹ Department of Histopathology, Hai Phong University of Medicine and Pharmacy, Hai Phong 180000, Vietnam.
¹⁰ Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
¹¹ Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan.
¹² Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.
¹³ Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.

PMID: 40647610
PMCID: PMC12248427
DOI: 10.3390/diagnostics15131610

Abstract

Background: Hepatitis B virus (HBV) infection affects glucose metabolism and increases diabetes risk; HBV vaccination may reduce this risk. The role of HBV immunity in diabetes prevention among individuals without HBV infection is underexplored. This study aims to evaluate whether HBV immunity reduces diabetes risk in individuals without HBV infection. Methods: This retrospective cohort study used de-identified electronic medical records from TriNetX. Adults with hepatitis B surface antibody (HBsAb) results without a history of HBV infection or diabetes were identified. Diabetes was defined on the basis of a diabetes diagnosis, diabetes medication use, or glycated hemoglobin ≥ 6.5%. Propensity score matching was conducted to balance demographics and comorbidities between groups. Results: The HBV-immunized group had a 15% lower diabetes risk than the HBV-unimmunized group (HR: 0.85 [0.84-0.87]). A dose-response effect was observed, with higher HBsAb levels showing a greater reduction in the risk of diabetes. HBsAb levels of ≥100 and ≥1000 mIU/mL were associated with 19% (HR: 0.81 [0.80-0.83]) and 43% (HR: 0.57 [0.54-0.60]) reductions in diabetes risk, respectively, compared with HBsAb < 10 mIU/mL. The reduced risk of diabetes was associated with age. Immunized individuals aged 18 to 44 years, 45 to 64 years, and ≥65 years had 20% (HR: 0.80 [0.78-0.82]), 11% (HR: 0.89 [0.87-0.92]), and 12% (HR: 0.88 [0.84-0.91]) lower diabetes risks, respectively, compared with unimmunized individuals. Conclusions: HBV immunity may be associated with a reduced risk of diabetes, suggesting broader HBV vaccination as a dual-benefit strategy for the prevention of hepatitis B and diabetes, especially in regions with a high prevalence of both diseases.

Keywords: diabetes mellitus; hepatitis B; immunity; prevention; vaccination.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

**Figure 1**
Flowchart of participant selection.

**Figure 2**
Kaplan–Meier curves of cumulative incidence of diabetes mellitus by composite outcome. *** p log-rank test < 0.001.

**Figure 3**
Dose–response effect of hepatitis B surface antibody levels and diabetes mellitus by composite outcome.

**Figure 4**
Risk of diabetes mellitus by composite outcome, stratified by region, age, and sex.

See this image and copyright information in PMC

References

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Potential Protective Effect of Hepatitis B Immunity Against Diabetes Mellitus: A Retrospective Propensity-Matched Cohort Study

Affiliations

Potential Protective Effect of Hepatitis B Immunity Against Diabetes Mellitus: A Retrospective Propensity-Matched Cohort Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources