Correlation of Insulin and/or Insulin Secretagogues with the Risk of Hepatocellular Carcinoma and All-Cause Mortality Among Patients with Chronic Hepatitis B and Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

内容摘要

Patients with chronic hepatitis B (CHB) have a higher risk of developing hepatocellular carcinoma (HCC), causing poor prognosis. Type 2 diabetes mellitus (T2DM), a common comorbidity of CHB, further elevates HCC risk. Insulin and insulin secretagogues are commonly used antidiabetic medications (ADMs) that&#xa0;lower blood glucose by elevating circulating insulin levels. This study aimed to explore the association of insulin and/or insulin secretagogues with the risk of HCC and all-cause mortality among patients with CHB and T2DM. This study included 696 patients diagnosed with CHB and T2DM between January 2016 and December 2019, who were divided into four groups. Group 1 received insulin and/or insulin secretagogues; Group 2 received no ADMs; Group 3 received other ADMs except for insulin and insulin secretagogues; Group 4 received insulin and/or insulin secretagogues in combination with other ADMs. Cox proportional hazards regression models were constructed to assess the risk of developing HCC and death. Subgroup analysis and sensitivity analysis were conducted to assess the robustness of the findings. Throughout the follow-up period (median 77.5 months for HCC, 80 months for all-cause mortality), Group 1&#xa0;had a significantly higher incidence of both HCC and all-cause mortality compared with other groups (both P < 0.001). After adjusting for potential covariates, compared with Group 2, Group 1 was associated with a higher risk of developing HCC (HR = 4.42, 95% CI: 1.75-11.17, P = 0.002) and all-cause mortality (HR = 2.46, 95% CI: 1.35-4.50, P = 0.003). Subgroup and sensitivity analyses confirmed robustness. This study found that the use of insulin and/or insulin secretagogues was associated with a higher incidence of HCC and all-cause mortality among patients with CHB and T2DM. However, when combining insulin and/or insulin secretagogues with other types of ADMs, no increased risk was observed.