Diabetes mellitus as a risk factor of liver cirrhosis in patients with chronic hepatitis B virus infection

Liver cirrhosis may occur in chronic hepatitis B surface antigen (HBsAg) ca rriers. Diabetes mellitus (DM)-associated chronic hepatitis may also occasi onally lead to cirrhosis; however, its role in the course of chronic HBsAg carriers has not been studied. A cohort of 500 HBsAg carriers (398 men; mea n age at entry, 42 +/- 15 years) were followed up longitudinally. After a m ean follow-up of 5.8 +/- 3.3 years, 71 (14.2%; 70 men) patients developed c irrhosis. Increased risks of cirrhosis were found among men and the elderly (p < 0.001). Fifteen (21.1%) cirrhotic patients were noted to have had DM for 2-15 years before the development of cirrhosis. By contrast, only eight (1.9%; p < 0.001) of the patients without cirrhosis developed DM. When cir rhotic patients were compared to 102 age- and sex-matched non-cirrhotic con trols, DM and elevation of serum alanine transaminase levels were found to be independent factors associated with the advent of cirrhosis in multivari ate analysis. Other factors, including acute exacerbation, bridging hepatic necrosis, and superinfection by hepatitis C or D viruses, were insignifica nt. Our results suggest that DM may play a role in the progression to liver cirrhosis in chronic HBsAg carriers. High-risk subjects should be closely monitored for late complications.