Toshihide Shima1, Hirofumi Uto2, Kohjiro Ueki3, Yutaka Kohgo4, Kohichiroh Yasui5, Naoto Nakamura6, Tatsuaki Nakatou7, Toshinari Takamura8, Sumio Kawata9, Kazuo Notsumata10, Kyoko Sakai11,12, Ryosuke Tateishi13, Takeshi Okanoue14. 1. Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan. 2. Department of Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. 3. Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College, Asahikawa, Japan. 5. Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. 6. Department of Endocrinology Diabetes and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan. 7. Diabetes Center, Okayama Saiseikai General Hospital, Okayama, Japan. 8. Department of Endocrinology and Metabolism, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. 9. Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan. 10. Department of Gastroenterology, Fukui-ken Saiseikai Hospital, Fukui, Japan. 11. Department of Clinical Laboratory, Saiseikai Suita Hospital, Suita, Japan. 12. Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan. 13. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 14. Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan. okanoue@suita.saiseikai.or.jp.
Abstract
BACKGROUND: We reported a cross-sectional study on causes of liver injury in Japanese type 2 diabetes mellitus (T2D) patients (JG 2013). We assessed overall and cause-specific mortality risk during follow-up of patients enrolled in JG 2013. METHODS: This was a longitudinal, multicenter cohort study. Of the 5642 Japanese T2D patients who visited T2D clinics of nine hospitals in the original study, 3,999 patients were followed up for an average of 4.5 years. Expected deaths in T2D patients were estimated using age-specific mortality rates in the general population (GP) of Japan. Standardized mortality ratios (SMRs) were calculated to compare mortality between T2D patients and GP. RESULTS: All-cancer mortality was significantly higher in T2D patients than in the GP [SMR 1.58, 95% confidence interval (CI) 1.33-1.87]. Among malignancies, hepatocellular carcinoma (HCC) conferred the highest mortality risk in T2D patients (SMR 3.57, 95% CI 2.41-5.10). HCC-associated mortality risk in T2D patients remained significantly high (SMR 2.56, 95% CI 1.64-3.97) after adjusting for high positivity rates of hepatitis B surface antigen (1.7%) and anti-hepatitis C virus (5.3%). In T2D patients with platelet counts < 200 × 103/μl, SMR of HCC increased from 3.57 to 6.58 (95% CI 4.34-9.58). T2D patients with platelet count > 200 × 103/μl showed no increase in mortality risk (SMR 0.68) of HCC. CONCLUSIONS: HCC-associated mortality risk was the highest among all cancers in Japanese T2D patients. Regular follow-up may be important for T2D patients with platelet counts < 200 × 103/μl for early detection of HCC.
BACKGROUND: We reported a cross-sectional study on causes of liver injury in Japanese type 2 diabetes mellitus (T2D) patients (JG 2013). We assessed overall and cause-specific mortality risk during follow-up of patients enrolled in JG 2013. METHODS: This was a longitudinal, multicenter cohort study. Of the 5642 Japanese T2D patients who visited T2D clinics of nine hospitals in the original study, 3,999 patients were followed up for an average of 4.5 years. Expected deaths in T2D patients were estimated using age-specific mortality rates in the general population (GP) of Japan. Standardized mortality ratios (SMRs) were calculated to compare mortality between T2D patients and GP. RESULTS: All-cancer mortality was significantly higher in T2D patients than in the GP [SMR 1.58, 95% confidence interval (CI) 1.33-1.87]. Among malignancies, hepatocellular carcinoma (HCC) conferred the highest mortality risk in T2D patients (SMR 3.57, 95% CI 2.41-5.10). HCC-associated mortality risk in T2D patients remained significantly high (SMR 2.56, 95% CI 1.64-3.97) after adjusting for high positivity rates of hepatitis B surface antigen (1.7%) and anti-hepatitis C virus (5.3%). In T2D patients with platelet counts < 200 × 103/μl, SMR of HCC increased from 3.57 to 6.58 (95% CI 4.34-9.58). T2D patients with platelet count > 200 × 103/μl showed no increase in mortality risk (SMR 0.68) of HCC. CONCLUSIONS:HCC-associated mortality risk was the highest among all cancers in Japanese T2D patients. Regular follow-up may be important for T2D patients with platelet counts < 200 × 103/μl for early detection of HCC.