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Multicenter Study
. 2025 Jul 14;9(8):e0734.
doi: 10.1097/HC9.0000000000000734. eCollection 2025 Aug 1.

Diabetes mellitus in alcohol-associated liver disease: Prevalence and outcomes

Ben Ward  1 , Mark Theodoreson  1   2 , Guruprasad Aithal  3 , Michael Allison  4 , Mayur Brahmania  5 , Ewan Forrest  6   7 , Hannes Hagström  8   9 , Steven Masson  10 , Anne McCune  11 , Keval Naik  4 , Neil Rajoriya  12 , Ian A Rowe  1   2 , Richard Parker  1   2
Affiliations
Multicenter Study

Diabetes mellitus in alcohol-associated liver disease: Prevalence and outcomes

Ben Ward et al. Hepatol Commun. .

Abstract

Background: Alcohol associated liver disease (ALD) is a common condition that is a significant global cause of morbidity and mortality. Diabetes mellitus (DM) increases the risk of adverse outcomes in other types of steatotic liver disease. This retrospective study sought to explore the relationship between ALD and DM.

Methods: The Worldwide Alcohol-related Liver Disease Outcomes (WALDO) study is an international multicenter cohort of patients with biopsy-proven ALD. The presence of DM at baseline or during follow-up was noted. Clinical events after index biopsy were noted, including death and liver-associated clinical events (LACE). Risks for adverse outcomes were assessed with Cox proportional hazard models with DM as a time-dependent variable to reflect periods of time without or with diabetes. All analyses were done in R.

Results: In total, 712 patients with a median age of 52 years were followed up for a median of 4.8 years (IQR: 1.2-9.5). At baseline, DM was present in 113 patients (15.9%), and a further 56 patients (7.8%) developed DM in follow-up. During follow-up, 113 patients developed LACE. One hundred fifty-two patients died from liver disease, and 46 underwent liver transplantation. DM was significantly associated with liver-related mortality (HR: 1.77, 1.15-2.73, p=0.009) and incident LACE (HR: 1.90, 1.23-2.95, p=0.004). In multivariable analysis, DM remained significantly associated with liver-related mortality (HR=1.79, 1.30-2.48, p<0.001).

Conclusions: DM is a frequent comorbidity in persons with ALD and is associated with a higher risk of liver-related mortality. Patients' diabetic status should be an important consideration for clinicians treating people with ALD.

Keywords: WALDO cohort; alcohol-associated liver disease; diabetes; mortality.

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Conflict of interest statement

Guruprasad Aithal consults for Clinipace, GSK, Amryth, Pfizer Inc., DNFi, BenevolentAI, Bio PureTech LYT, Merck Healthcare, KGaA, Agios, Astra Zeneca, Suzhou, MDCE Co. LTD, JnJ, and SynOx Therapeutics. Michael Allison received grants from GSK. Steven Masson consults and advises Orphalan Pharmaceuticals. He is on the speaker’s bureau for Norgine Pharmaceuticals. Ian Rowe consults for Novo Nordisk and Boehringer Ingelheim. He is on the speaker’s bureau for Bayer. Richard Parker advises and received grants from Orphalan. He consults for Durect Corporation. He is on the speaker’s bureau for Noringer. The remaining authors have no conflicts to report.

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