Digestive Diseases and Sciences

, Volume 61, Issue 11, pp 3335–3345 | Cite as

Diabetes Is Associated with Clinical Decompensation Events in Patients with Cirrhosis

  • Tsai-Ling Liu
  • Justin Trogdon
  • Morris Weinberger
  • Bruce Fried
  • A. Sidney BarrittIVEmail author
Original Article



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.


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.


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.


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.


Liver diseases Multiple chronic conditions Secondary data 



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).


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.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2016_4261_MOESM1_ESM.docx (920 kb)
Supplementary material 1 (DOCX 919 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Tsai-Ling Liu
    • 1
  • Justin Trogdon
    • 2
  • Morris Weinberger
    • 3
    • 4
  • Bruce Fried
    • 5
  • A. Sidney BarrittIV
    • 6
    Email author
  1. 1.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Durham VAMC Center for Health Services ResearchDurhamUSA
  5. 5.Department of Health Policy and Management, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  6. 6.Division of Gastroenterology and HepatologyUniversity of North Carolina at Chapel HillChapel HillUSA

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