Glycated hemoglobin and antidiabetic strategies as risk factors for hepatocellular carcinoma

AIM: To evaluate the relationship between glycemic control [assessed by glycated hemoglobin (HbA1c)], antidiabetic therapies and the risk of hepatocellular carcinoma (HCC).METHODS: We recruited 465 patients with HCC, 618 cases with liver cirrhosis and 490 controls with no liver disease. Among subjects with type 2 diabetes mellitus (DM2), the associations between the antidiabetic strategies and HbA1c level with HCC were determined through 2 series of multivariate logistic regression models using cirrhotic patients and controls as comparison groups. RESULTS: DM2 prevalence was 31.2% in patients with HCC, 23.2% in cirrhotic patients and 12.6% in controls (P < 0.0001). In 86% of study subjects, DM2 had been diagnosed for more than 1 year before the HCC diagnosis. HCC patients with DM2 had a 1.52.5fold increased risk of liver cancer. The HbA1c mean levels were signif icantly higher in DM2 patients with HCC than in cirrhoticand control DM2 patients. Antidiabetic treatment with metformin was more common among cirrhotic and control DM2 subjects than among cases with HCC. In both series of multivariate analyses, treatment with metformin signif icantly reduced the risk of HCC by more than 80% compared with sulphonylureas and insulin therapy. No signif icant differences were seen between sulphonylureas and insulin treatment. Elevated HbA1c levels were positively related to the risk for HCC in diabetic patients, with a 26%50% increase in risk for each 1% increase in HbA1c values.CONCLUSION: In patients with preexisting DM2, the risk of HCC is positively associated with poor chronic glycemic control and significantly decreased by metformin therapy.

Glycaemic control, antidiabetic medications and influenza vaccination coverage among patients with diabetes in Udine, Italy

Objective The objectives of this study were to estimate influenza vaccination coverage among patients with diabetes mellitus in an Italian 250000-inhabitant area in the 2017-2018 season and to assess whether glycaemic control and pharmacological treatment were associated with the likelihood of being vaccinated.Design In this cross-sectional study,we analysed anonymous health administrative databases,linked with each other at the individual patient level through a stochastic key:diabetes mellitus registry,vaccinations,drug prescriptions and laboratory database.setting The study was conducted in the catchment area of the University Hospital of Udine(‘the Udine area’),a 250000-inhabitant area in the northeast of Italy.Participants The study included all subjects included in the regional registry of patients with diabetes mellitus,living in the Udine area as of 1 October 2017.Main outcome measures Vaccination coverage in the 2017-2018 influenza season was calculated.The association between patients’characteristics and the likelihood of being vaccinated was assessed through multivariate log binomial regression.result 53.0%of 15900 patients with diabetes living in the area were vaccinated.Coverage increased with age,approaching 75%at≥85 years.Patients lacking recent glycated haemoglobin testing were less likely to be vaccinated(43.4%vaccination coverage),as were those not treated pharmacologically(44.4%vaccination coverage).Patients treated with both insulin,metformin and other antidiabetic medications were more likely to be vaccinated than those treated with metformin alone(58.1%vaccination coverage;adjusted relative risk=1.07,95%CI 1.01 to 1.14).Conclusion Influenza vaccination coverage was suboptimal in this Italian population of patients with diabetes.Strategies to improve diabetes management could in turn positively affect influenza coverage.