Diabetes has been identified as a critical factor in the poor clinical outcomes of patients with primary biliary cholangitis (PBC), a chronic liver disease. Research presented at The Liver Meeting 2024 by Ellen Werner, PhD, a researcher from Erasmus University Medical Center, found that diabetes significantly reduces transplant-free survival rates and increases the likelihood of liver-related complications in PBC patients.
The study, which analyzed data from the Dutch PBC Cohort Study (DPCS), included 4,256 PBC patients from 71 hospitals across the Netherlands. It found that patients with diabetes faced substantially worse long-term outcomes than their non-diabetic counterparts. This included a significantly lower 10-year transplant-free survival rate—70.7% for diabetic patients compared to 87.0% for those without diabetes.
Werner and her team’s analysis highlights diabetes as an independent predictor of negative clinical outcomes in PBC. The study found that patients with diabetes had a higher risk of liver transplantation or death, as well as liver-specific events like decompensated cirrhosis. Even after adjusting for factors such as age, gender, and liver disease severity, diabetes remained a significant risk factor, increasing the hazard for poor outcomes by 70% (adjusted hazard ratio of 1.7).
The DPCS cohort also showed that diabetic patients had a higher incidence of cirrhosis at the time of diagnosis, as well as a less favorable response to treatment with ursodeoxycholic acid (UDCA), a standard medication for PBC. Despite treatment, only 55.2% of diabetic patients achieved the Paris-2 response criteria after one year of UDCA therapy, compared to 57.6% in non-diabetic patients—a difference that, while not statistically significant, indicates a trend toward poorer response in the diabetic group.
As the study underscores the growing issue of metabolic comorbidities in liver disease, these findings are critical for clinical management. With the recent expansion of treatment options for PBC, including FDA-approved drugs like elafibranor and seladelpar, identifying high-risk patients, particularly those with diabetes, could help guide more effective, individualized care.
The research calls attention to the need for clinicians to closely monitor diabetic PBC patients for signs of disease progression and consider more aggressive management to improve transplant-free survival and overall outcomes.
“In this large, nationwide cohort, diabetes emerged as a key independent predictor of adverse liver transplant-free survival in PBC patients, driven in part by an accelerated progression to end-stage liver disease,” concluded Werner.
These findings emphasize the importance of addressing metabolic comorbidities in liver disease management and highlight the need for more research into the impact of diabetes on liver disease progression and response to treatment.
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