Is insulin the preferred treatment in persons with type 2 diabetes and
liver cirrhosis?
Abstract
Aim: Insulin is highly recommended for diabetes management in persons
with liver cirrhosis. However, insulin has some deleterious side
effects, and only few studies have evaluated its long-term effects in
persons with cirrhosis. We conducted this cohort study to compare the
risks of all-cause mortality, liver-related complications,
cardiovascular events, and hypoglycemia between insulin users and
nonusers with type 2 diabetes mellitus (T2DM) and compensated liver
cirrhosis. Methods: From January 1, 2000, to December 31, 2012, we
selected 2047 insulin users and 4094 propensity score-matched nonusers
from Taiwan’s National Health Insurance Research Database. Cox
proportional hazard models with robust sandwich standard error estimates
were used to assess the risks of main outcomes between insulin users and
nonusers. Results: The mean follow-up time was 5.84 years. The death
rate during the follow-up period was 5.28 and 4.07 per 100 person-years
for insulin users and nonusers, respectively. In insulin users, the
hazard ratios and 95% confidence intervals (CIs) of all-cause
mortality, hepatocellular carcinoma, decompensated cirrhosis, hepatic
failure, major cardiovascular events, and hypoglycemia were 1.31
(1.18-1.45), 1.18 (1.05-1.34), 1.53 (1.35-1.72), 1.26 (1.42-1.86), 1.41
(1.23-1.62), and 3.33 (2.45-4.53), respectively. Conclusions: This
retrospective cohort study indicated that among persons with T2DM and
compensated liver cirrhosis, insulin users demonstrated with higher
risks of death, liver-related complications, cardiovascular events, and
hypoglycemia compared with insulin nonusers. Therefore, vigilance is
recommended when such persons use insulin.