Public Release Type:
Journal
Publication Year: 2013
Authors:
Lisker-Melman M,
Chung RT,
Ghany MG,
Terrault N,
Khalili M,
Brunt EM,
Cloonan YK,
Kim WR,
Lau D,
Lok AS,
Sanyal AJ
Studies:
Hepatitis B Research Network
Background/Aims: Diabetes is associated with increased risk of hepatocellular carcinoma (HCC) and disease progression in chronic liver disease but factors associated with diabetes in patients infected with hepatitis B virus (HBV) living in North America (NA) have not been previously studied. Therefore, we set out to determine the rates and factors predictive of diabetes and impaired fasting glucose (IFG) in a large multi-ethnic NA cohort of patients infected with HBV. Methods: HBsAg+ adults without liver decompensation, HCC, liver transplant, HIV or current antiviral therapy from 21 US/Canada centers were enrolled. Those with known diabetes or fasting glucose data were included in the analysis. Diabetes was defined by history/ medications or fasting glucose ≥126 mg/dL and IFG as fasting glucose 110-125 mg/dL. Overweight/obese was defined by race-adjusted BMI. Results: 900 patients were included in the analysis: median age 43 years, 51% male, 71% Asian (14% black, 11% white), 81% born outside US/Canada (30% migrated >20 yrs ago). Most whites were born in NA, while 66% of blacks, and 92% of Asians were born in Africa and Asia, respectively. Median BMI (Kg/m2) was 27 in whites, 28 in blacks, 23 in Asians. 27% were HBeAg+, 20% had HBV DNA >10^7 IU/mL and 4% had cirrhosis. 70 (8%) patients had IFG and 112 (12%) had diabetes. Diabetes rate by racial category and birth place were: 24% in blacks, 18% in whites, 9% in Asians, and 13% in other races; 21% in NA-born, 15% in foreign-born (FB) migrated >20 yrs, and 6% in FB migrated<20 yrs. On univariable analysis, compared to those with normal glucose (N=718), diabetes was associated with older age (OR 1.08), race (black OR 1.49; Asian OR 0.43), overweight/obese (OR 4.04), cirrhosis (OR 2.99), diabetes family history (OR 3.9), NA birth (OR 2.03), FB migrated ≤ 20 yrs ago (OR 0.40), moderate alcohol intake (OR 0.55), and HBeAg+ status (OR 0.50). On multivariable analysis, independent predictors of diabetes were age (OR 1.08, 95%CI (CI) 1.05-1.12), black (vs white) race (OR 3.13, CI 1.22-8.02), overweight/obese (3.29, CI 1.76-6.14), diabetes family history (OR 3.55, CI 1.94-6.47), and ALT (≥2x ULN, OR 1.91, CI 1.07-3.41). Independent predictors of IFG were age (OR 1.04, CI 1.02-1.07) and overweight/obese (OR 2.17, CI 1.03-4.51). Conclusion: In this large NA multi-ethnic and mostly foreign-born HBV-infected cohort, diabetes and prediabetes were associated with known risks and the main modifiable factor is obesity. These results highlight the opportunities for interventions to prevent diabetes especially among the at-risk ethnic groups with HBV infection.