Liver-Related Mortality Risk Triples in Type 2 Diabetes compared to those without diabetes: Study

A new study published in the journal of Liver International showed that persons with type 2 diabetes had a threefold increased chance of dying from liver disease when compared to people without diabetes. High FIB-4 scores, advanced age, male gender, poor glycemic control, and alcohol use were important risk factors. Insulin was associated with increased risk, but GLP-1 RAs and SGLT2 inhibitors were associated with decreased liver mortality.

Death from liver conditions like cirrhosis, liver cancer, or acute liver failure is referred to as hepatic mortality. Hepatic mortality is considerably higher in individuals with diabetes mellitus, particularly type 2 diabetes (T2DM). Non-alcoholic fatty liver disease (NAFLD) and its more severe variant, non-alcoholic steatohepatitis (NASH), are mostly caused by metabolic abnormalities that can lead to cirrhosis, fibrosis, and hepatocellular carcinoma (HCC).

It is becoming more well acknowledged that diabetes and liver disease are related and that they significantly increase mortality. Thereby, this 10-year observational research by Carlo Giorda and team evaluated the mortality risk from hepatic causes in adults with type 2 diabetes to those without the disease.

The research involved more than 4 million people in the Piedmont area of Italy between the ages of 35 and 85, tracked 1,00,611 newly diagnosed diabetes patients for a median of 6.5 years. Standardized mortality rates (SMR) were utilized to analyze liver disease mortality rates, and Poisson regression was performed to evaluate the associations between clinical factors and mortality in the diabetic population.

When compared to those without diabetes, those with diabetes had a threefold increased risk of liver-related death (9.96 per 10,000 in the diabetic group vs. 3.02 per 10,000 in the non-diabetic population). Hepatocellular carcinoma and steatotic liver disease linked to metabolic dysfunction were the main causes of mortality in the liver.

Male gender, advanced age, high FIB-4 scores (which indicate liver fibrosis), poor glycemic control (HbA1c > 9%), and a history of alcohol misuse were important risk factors for increased hepatic mortality. Notably, lower liver mortality was linked to antidiabetic medications, especially more recent ones like SGLT2 inhibitors and GLP-1 RAs. However, insulin administration was associated with increased mortality.

Overall, with an emphasis on glycemic management, liver fibrosis evaluation, and alcohol intake reduction, this study emphasizes the necessity of focused therapies to address hepatic problems in diabetic patients.

Source:

Giorda, C. B., Picariello, R., Tartaglino, B., Nada, E., Costa, G., & Gnavi, R. (2025). Mortality for any hepatic cause in people with diabetes compared to the non-diabetic population. A 10-year-observational study. Liver International: Official Journal of the International Association for the Study of the Liver, 45(5), e70075. https://doi.org/10.1111/liv.70075