Diabetes, hepatocellular carcinoma, and mortality in hepatitis C ‐infected patients: a population‐based cohort study

Abstract Background and AimThe effect of diabetes mellitus (DM) on the development of hepatocellular carcinoma (HCC) and all‐cause mortality after HCC development in chronic hepatitis C virus (HCV) infected patients remains inconclusive. This cohort study aimed to investigate these issues using the Taiwanese National Health Insurance Research Database. MethodsWe retrieved and enrolled newly diagnosed DM patients with HCV from the Longitudinal Cohort of Diabetes Patients database. Propensity score matching—including age, sex, alcohol‐related liver disease, and baseline liver cirrhosis—was used to identify and enroll HCV patients without DM from the Longitudinal Health Insurance Database (n = 1,686). A multi‐state model was used to investigate transitions from “start‐to‐HCC”, “start‐to‐death”, and “HCC‐to‐death”. ResultsThe multi‐state model showed higher cumulative hazards for “start‐to‐HCC”, “start‐to‐death”, and “HCC‐to‐death” transitions in the DM (vs. non‐DM) cohort. The cumulative probability of death with or without HCC after 10 years of follow‐up was higher in the DM cohort than in the non‐DM cohort. Multivariable transition‐specific Cox models demonstrated that DM significantly increased the risk for transition from “start‐to‐HCC” (adjusted hazard ratio [aHR] 1.36; 95% confidence interval [CI] 1.16–1.59; ...
Source: Journal of Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Original Article ‐ Hepatology (Clinical) Source Type: research

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Antipsychotic medications are a vital part of controlling psychosis in schizophrenic patients. However, when those patients live in nursing facilities, we are obligated by CMS to undertake gradual dose reductions of antipsychotic medication if possible. Sometimes, these efforts are successful and sometimes they fail. Antipsychotic medications have many side effects, including sedation, diabetes, hyperlipidemia, weight gain, motor rigidity, impaired gait, and falls. Monitoring of blood glucose, lipids, and extrapyramidal symptoms is mandatory.
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a distinction between hospital and post-acute settings regarding diabetes management. The current diabetes management care-set in the EHR of our large healthcare system includes checking the blood sugar QID/AC/HS (before breakfast, lunch and dinner, and bedtime).
Source: Journal of the American Medical Directors Association - Category: Health Management Authors: Source Type: research
Abstract Type 2 diabetes mellitus (T2DM) is an endocrine disorder encompassing multifactorial mechanisms, and chronic hepatitis C virus infection (CHC) is a multifaceted disorder, associated with extrahepatic manifestations, including endocrinological disorders. CHC and T2DM are associated, but the subject remains controversial. We performed a systematic review and meta-analysis evaluating such association, searching on PubMed until February 29, 2016. Inclusion criteria were: 1) presence of at least one internal control group age- and gender-matched (non-hepatopathic controls; and/or hepatopathic, not HCV-positive...
Source: ENDOCR REV - Category: Endocrinology Authors: Tags: Rev Endocr Metab Disord Source Type: research
AbstractType 2 diabetes mellitus (T2DM) is an endocrine disorder encompassing multifactorial mechanisms, and chronic hepatitis C virus infection (CHC) is a multifaceted disorder, associated with extrahepatic manifestations, including endocrinological disorders. CHC and T2DM are associated, but the subject remains controversial. We performed a systematic review and meta-analysis evaluating such association, searching on PubMed until February 29, 2016. Inclusion criteria were: 1) presence of at least one internal control group age- and gender-matched (non-hepatopathic controls; and/or hepatopathic, not HCV-positive, controls...
Source: Reviews in Endocrine and Metabolic Disorders - Category: Endocrinology Source Type: research
ConclusionsIFN‐free direct‐acting antiviral therapy of chronic hepatitis C does not alter the short‐term risk for HCC in patients with liver cirrhosis. A reduced HCC incidence may become evident after more than 1.5 years of follow‐up.
Source: Alimentary Pharmacology and Therapeutics - Category: Drugs & Pharmacology Authors: Tags: ORIGINAL ARTICLE Source Type: research
Conclusion Among chronic HCV patients, the highest risk of DM and MetSyn was seen among older patients, African Americans, and women. These groups are at higher risk of cirrhosis and HCC due to concurrent NAFLD.
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research
Conclusions. Diabetes mellitus and cirrhosis are strong risk factors for HCC development after SVR has been achieved. The risk to develop HCC diminishes significantly 2 years after SVR. Patients without cirrhosis have a low risk to develop HCC after SVR, and the benefit of HCC surveillance for this group is questionable.
Source: Clinical Infectious Diseases - Category: Infectious Diseases Authors: Tags: ARTICLES AND COMMENTARIES Source Type: research
Non-alcoholic fatty liver disease (NAFLD) encompasses a spectrum of liver diseases from simple steatosis with hepatic lipid accumulation to end-stage liver disease with decompensated cirrhosis, liver failure and hepatocellular carcinoma. Recent data from the USA showed that in 2013, NAFLD was the second most frequent indication for liver transplantation behind hepatitis C. Since there are now effective treatments for hepatitis C and there is currently no licensed treatment for NAFLD, it has been predicted that over the next 10-15 years, NAFLD will replace hepatitis C as the most frequent indication for liver transplantatio...
Source: Digestive Diseases - Category: Gastroenterology Source Type: research
rreal-Pérez JZ, Maldonado-Garza HJ Abstract Diabetes mellitus (DM) that occurs because of chronic liver disease (CLD) is known as hepatogenous diabetes (HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus (HCV) and glucose metabolism mechanisms and genetic susc...
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Tags: World J Gastroenterol Source Type: research
Authors: Iovanescu VF, Streba CT, Ionescu M, Constantinescu AF, Vere CC, Rogoveanu I, Moța E Abstract Hypothesis: Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. Objectives: Our study had multiple purposes: to determine the frequency of the association between chronic viral l...
Source: Journal of Medicine and Life - Category: Journals (General) Tags: J Med Life Source Type: research
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