What this study adds
․Our study indicated that among persons with T2DM and compensated liver
cirrhosis, insulin users were associated with higher risks of death,
liver-related complications, cardiovascular events, and hypoglycemia
compared with insulin nonusers
Aim: Insulin is highly
recommended for diabetes management in persons with liver cirrhosis.
However, insulin has some deleterious side effects, and only few studies
have evaluated its long-term effects in persons with cirrhosis. We
conducted this cohort study to compare the risks of all-cause mortality,
liver-related complications, cardiovascular events, and hypoglycemia
between insulin users and nonusers with type 2 diabetes mellitus (T2DM)
and compensated liver cirrhosis.
Methods: From January 1, 2000, to December 31, 2012, we
selected 2047 insulin users and 4094 propensity score-matched nonusers
from Taiwan’s National Health Insurance Research Database. Cox
proportional hazard models with robust sandwich standard error estimates
were used to assess the risks of main outcomes between insulin users and
nonusers.
Results: The mean follow-up time was 5.84 years. The death rate
during the follow-up period was 5.28 and 4.07 per 100 person-years for
insulin users and nonusers, respectively. In insulin users, the hazard
ratios and 95% confidence intervals (CIs) of all-cause mortality,
hepatocellular carcinoma, decompensated cirrhosis, hepatic failure,
major cardiovascular events, and hypoglycemia were 1.31 (1.18-1.45),
1.18 (1.05-1.34), 1.53 (1.35-1.72), 1.26 (1.42-1.86), 1.41 (1.23-1.62),
and 3.33 (2.45-4.53), respectively.
Conclusions: This retrospective cohort study indicated that
among persons with T2DM and compensated liver cirrhosis, insulin users
demonstrated with higher risks of death, liver-related complications,
cardiovascular events, and hypoglycemia compared with insulin nonusers.
Therefore, vigilance is recommended when such persons use insulin.