Cardiovascular Disease, Cancer, and Mortality Among People With Type 2 Diabetes and Alcoholic or Nonalcoholic Fatty Liver Disease Hospital Admission

Sarah H Wild (Lead / Corresponding author), Jeremy J Walker, Joanne R Morling, David A McAllister, Helen M Colhoun, Bassam Farran, Stuart McGurnaghan, Rory McCrimmon, Stephanie H Read, Naveed Sattar, Christopher D Byrne, Scottish Diabetes Research Network Epidemiology Group

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    Objective: To describe associations between alcoholic liver disease (ALD) or nonalcoholic fatty liver disease (NAFLD) hospital admission and cardiovascular disease (CVD), cancer, and mortality in people with type 2 diabetes mellitus (T2DM).

    Research Design and Methods: We performed a retrospective cohort study by using linked population-based routine data from diabetes registry, hospital, cancer, and death records for people ages 40-89 years diagnosed with T2DM in Scotland between 2004 and 2013 who had one or more hospital admission records. Liver disease and outcomes were identified by using ICD-9 and -10 codes. We estimated hazard ratios (HRs) from Cox proportional hazards regression models, adjusting for key risk factors.

    Results: A total of 134,368 people with T2DM (1,707 with ALD and 1,452 with NAFLD) were studied, with a mean follow-up of 4.3 years for CVD and 4.7 years for mortality. Among those with ALD, NAFLD, or without liver disease hospital records 378, 320, and 21,873 CVD events; 268, 176, and 15,101 cancers; and 724, 221, and 16,203 deaths were reported, respectively. For ALD and NAFLD, respectively, adjusted HRs (95% CIs) compared with the group with no record of liver disease were 1.59 (1.43, 1.76) and 1.70 (1.52, 1.90) for CVD, 40.3 (28.8, 56.5) and 19.12 (11.71, 31.2) for hepatocellular carcinoma (HCC), 1.28 (1.12, 1.47) and 1.10 (0.94, 1.29) for non-HCC cancer, and 4.86 (4.50, 5.24) and 1.60 (1.40, 1.83) for all-cause mortality.

    Conclusions: Hospital records of ALD or NAFLD are associated to varying degrees with an increased risk of CVD, cancer, and mortality among people with T2DM.

    Original languageEnglish
    Article numberdc171590
    Pages (from-to)341-347
    Number of pages7
    JournalDiabetes Care
    Issue number2
    Early online date22 Nov 2017
    Publication statusPublished - Feb 2018


    • Adult
    • Aged
    • Aged, 80 and over
    • Carcinoma, Hepatocellular/complications
    • Cardiovascular Diseases/epidemiology
    • Diabetes Complications/epidemiology
    • Diabetes Mellitus, Type 2/complications
    • Female
    • Hospitalization/statistics & numerical data
    • Humans
    • Liver Diseases, Alcoholic/complications
    • Liver Neoplasms/complications
    • Male
    • Middle Aged
    • Mortality
    • Neoplasms/epidemiology
    • Non-alcoholic Fatty Liver Disease/complications
    • Patient Admission/statistics & numerical data
    • Retrospective Studies
    • Risk Factors
    • Scotland/epidemiology

    ASJC Scopus subject areas

    • Advanced and Specialised Nursing
    • Internal Medicine
    • Endocrinology, Diabetes and Metabolism


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