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Diabetes Is Associated with Clinical Decompensation Events in Patients with Cirrhosis

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Abstract

Objectives

Liver cirrhosis is a leading cause of morbidity and mortality in the USA. Diabetes is common and increasing in incidence. Patients with compensated cirrhosis and diabetes may be at greater risk of clinical decompensation. We examined the risk of decompensation among a large sample of working-aged insured patients dually diagnosed with compensated cirrhosis and diabetes.

Methods

This retrospective study used MarketScan® Commercial Claims and Encounters and Medicare Supplemental Databases (2000–2013). Decompensation events included incident ascites, spontaneous bacterial peritonitis, variceal bleeding, hepatic encephalopathy, acute renal failure, and hepatocellular carcinoma. Dually diagnosed patients were defined as patients with cirrhosis and diabetes using previously published ICD-9 coding strategies. Adjusted odds ratios (ORs), hazard ratios (HRs), and confidence intervals (CI) were estimated using logistic regression and Cox proportional hazard models.

Results

Of 72,731 patients with compensated cirrhosis, 20,477 patients (28.15 %) were diagnosed with diabetes. After controlling for patient characteristics and medication usage, the odds of developing any decompensation event were 1.14 times higher for patients with cirrhosis and diabetes than for patients with cirrhosis only (95 % CI 1.08–1.21, P value <0.01). In the Cox proportional hazard model, patients who were dually diagnosed with diabetes had a 1.32 times higher HR (95 % CI 1.26–1.39, P value <0.01) after controlling for time-to-event.

Conclusions

Patients dually diagnosed with compensated cirrhosis and diabetes had a higher risk of having decompensation events. Careful management of diabetes in patients with liver disease may reduce the risk of clinical decompensation in this population.

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Acknowledgments

The database infrastructure used for this project was funded by the Department of Epidemiology, UNC Gillings School of Global Public Health; the Cecil G. Sheps Center for Health Services Research, UNC; the CER Strategic Initiative of UNC’s Clinical Translational Science Award (1 ULI RR025747); and the UNC School of Medicine. Tsai-Ling Liu was supported by a predoctoral Fellowship from Worldwide Health Economics and Outcomes Research at Bristol-Myers Squibb (BMS). BMS had no role in the study design, analysis, interpretation; preparation, review, approval, or decision to submit the manuscript for publication. Morris Weinberger was supported by a VA Health Services Research Senior Career Scientist Award (RCS 91-408).

Funding

This study was sponsored by a predoctoral Fellowship from Worldwide Health Economics and Outcomes Research at Bristol-Myers Squibb when the research was conducted. The funding and supporting organization had no role in the study design, analysis, interpretation of the data, preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101 McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA

    Tsai-Ling Liu

  2. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1101B McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA

    Justin Trogdon

  3. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105B McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA

    Morris Weinberger

  4. Durham VAMC Center for Health Services Research, Durham, NC, USA

    Morris Weinberger

  5. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1104E McGavran-Greenberg Hall, CB #7411, Chapel Hill, NC, 27599-7411, USA

    Bruce Fried

  6. Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 8004 Burnett Womack, CB #7584, Chapel Hill, NC, 27599-7584, USA

    A. Sidney Barritt IV

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  1. Tsai-Ling Liu
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  2. Justin Trogdon
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Correspondence to A. Sidney Barritt IV.

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Liu, TL., Trogdon, J., Weinberger, M. et al. Diabetes Is Associated with Clinical Decompensation Events in Patients with Cirrhosis. Dig Dis Sci 61, 3335–3345 (2016). https://doi.org/10.1007/s10620-016-4261-8

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  • DOI: https://doi.org/10.1007/s10620-016-4261-8

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