Factors that impact the outcomes of patients with non-alcoholic steatohepatitis (NASH) related cirrhosis are not clearly understood. A recent study explored the link of type 2 diabetes, levels of hemoglobin A1c (HbA1c), and use of antidiabetic medications with survival and liver-related events in patients with NASH and compensated cirrhosis.

Data were gathered from 299 patients with biopsy-proven NASH with Child-Pugh A cirrhosis from tertiary hospitals from Spain, Australia, Hong Kong, and Cuba, between April 1995 and December 2016. Information was collected on the presence of type 2 diabetes, level of HbA1c, and use of antidiabetic medications. Cox proportional and competing risk models helped assess and compare the rates of transplant-free survival, hepatic decompensation, and hepatocellular carcinoma (HCC).

In all, 212 patients had type 2 diabetes at baseline. Eight of the 87 patients developed diabetes over a median follow-up time of 5.1 years (range, 0.5-10.0 years). A lower proportion of patients with diabetes were seen to survive the entire follow-up period (38%) compared to patients with no diabetes (81%). A higher proportion of patients with diabetes had hepatic decompensation (51%) compared to 26% of patients with no diabetes, as well as HCC (25% vs. 7% of patients with no diabetes). Averaged annual HbA1c levels had no association with outcomes.

Metformin use over time was tied to a significant reduction in risk of death or liver transplantation, hepatic decompensation, and HCC. Metformin use led to a significant reduction in the risk of hepatic decompensation and HCC only in subjects with HbA1c levels over 7.0%.

In this international cohort of patients with biopsy-proven NASH and Child-Pugh A cirrhosis, type 2 diabetes was shown to heighten the risk of death and liver-related outcomes, including HCC. Patients taking metformin had higher rates of survival and lower rates of decompensation and HCC.

Source: Vilar-Gomez E, Calzadilla-Bertot L, Wai-Sun Wong V, et al. Type 2 Diabetes and Metformin Use Associate With Outcomes of Patients With Non-alcoholic Steatohepatitis-related, Child-Pugh A Cirrhosis. Clin Gastroenterol Hepatol. 2020 May 7. pii: S1542-3565(20)30633-9.