Adults with newly diagnosed diabetes at risk of liver disease

Adults with newly diagnosed diabetes are at higher long-term risk of serious liver disease, including cirrhosis and liver failure, according to a research article published in CMAJ (Canadian Medical Association Journal).

The negative impact of diabetes on the eye, kidney and blood vessels is well-known, but little is known about its effect on the liver.

A study conducted over 13 years by researchers from St. Michael's Hospital, University of Toronto and the Institute for Clinical Evaluative Sciences in Toronto included 438 069 adults aged 30 to 75 years with newly diagnosed diabetes over a 13 year period and a comparable group of 2 059 709 people without diabetes. They found an incidence rate of 8 per 10 000 person-years for serious liver disease in people with newly diagnosed diabetes compared to a rate of 4 per 10 000 person years among non-diabetic controls. They note that persons with diabetes and concomitant obesity or hypertension had the highest risk of liver disease.

"We posit that the presence of overt diabetes reflects more severe insulin resistance, a greater fatty load in the liver and potentially worse hepatic inflammation and injury," write Drs. Joel Ray and Gillian Booth of St. Michael's Hospital. "Those who have diabetes may not just have higher blood sugars, but greater long-term insulin resistance and fatty load to the liver, which ultimately impacts on the integrity of the liver's cells."

A previous study by the US Department of Veterans Affairs found that the incidence of serious liver disease was two times higher in people with diabetes, although the study sample comprised older men in hospital.

The authors suggest that the effects of weight loss and glycemic and lipid control should be better understood before instituting annual screening for liver disease.