Diabetes Mellitus is Associated With Higher Risk of Developing Decompensated Cirrhosis in Chronic Hepatitis C Patients

Abstract

Goals: To investigate the association of diabetes with risk of decompensated cirrhosis in patients with chronic hepatitis C (CHC).

Background: Direct-acting antivirals are highly effective in treating CHC but very expensive. CHC patients at high risk of progression to symptomatic liver disease may benefit most from early treatment.

Study: We conducted a retrospective cohort study using the 2006 to 2013 Truven Health Analytics MarketScan Commercial Claims and Encounters database including inpatient, outpatient, and pharmacy claims from private insurers. CHC and cirrhosis were identified using ICD-9-CM diagnosis codes; baseline diabetes was identified by diagnosis codes or antidiabetic medications. CHC patients were followed to identify decompensated cirrhosis. Multivariable Cox proportional hazards regression was used to model the risk of decompensated cirrhosis by baseline cirrhosis.

Results: There were 75,805 CHC patients with median 1.9 years follow-up. A total of 10,317 (13.6%) of the CHC population had diabetes. The rates of decompensated cirrhosis per 1000 person-years were: 185.5 for persons with baseline cirrhosis and diabetes, 119.8 for persons with cirrhosis and no diabetes, 35.3 for persons with no cirrhosis and diabetes, and 17.1 for persons with no cirrhosis and no diabetes. Diabetes was associated with increased risk of decompensated cirrhosis in persons with baseline cirrhosis (adjusted hazard ratio=1.4; 95% confidence interval, 1.3-1.6) and in persons without baseline cirrhosis (adjusted hazard ratio=1.9; 95% confidence interval, 1.7-2.1).

Conclusions: In a privately insured US population with CHC, the adjusted risk of decompensated cirrhosis was higher in diabetic compared with nondiabetic patients. Diabetes status should be included in prioritization of antiviral treatment.

Figure 1

Illustration of Study Design Chronic hepatitis C was defined by ICD-9-CM diagnosis codes: having ≥1 inpatient facility code for chronic hepatitis, or having ≥1 hepatitis C code (acute or chronic) followed by a chronic hepatitis C code >30 and ≤180 days apart on outpatient or provider claims. Decompensated cirrhosis included any of: bleeding esophageal varices, ascites, hepatic encephalopathy, hepatocellular carcinoma, spontaneous bacterial peritonitis or hepatorenal syndrome.

Figure 2

Algorithm with Inclusion/Exclusion Criteria to Identify Patients with Chronic Hepatitis C from Health Insurer Claims Data *The baseline period was defined as the first 6 months beginning on the date when chronic hepatitis C definition was met

Figure 3

Kaplan-Meier Curves of Decompensated Cirrhosis-free Survival Stratified by Cirrhosis and Diabetes at Baseline Decompensated cirrhosis included any of: bleeding esophageal varices, ascites, hepatic encephalopathy, hepatocellular carcinoma, spontaneous bacterial peritonitis or hepatorenal syndrome. Neither= neither cirrhosis nor diabetes, both= both cirrhosis and diabetes