An Italian study has revealed that patients with type 2 diabetes mellitus (DM2) have a significantly increased risk of hepatocellular carcinoma (HCC).
Dr. Valter Donadon from Pordenone Hospital of Italy, who investigated the relationships between DM2 and risk of HCC in a large population based case-control study, also found that DM2 pre-exists to the development of HCC in most cases.
Describing the study in the World Journal of Gastroenterology, Donadon said that the research team had enrolled 465 consecutive patients with HCC compared with an age and sex matched control group of 490 subjects.
The researcher said that the new findings suggested that DM2 is more likely a concourse rather than merely a consequence of the liver tumour, a conclusion supported by the finding of a similar frequency and severity of DM2 in patients with small HCC detected during follow-up of cirrhosis and in those with more advanced and diffuse cancers detected outside of a surveillance program.
The researchers said that the observation that patients with DM2, particularly males, treated with insulin had an increased frequency of HCC was intriguing and clinically relevant.
According to them, their findings go to show that it is very important to closely observe HCC in patients with chronic liver disease and DM2, particularly when males are treated with insulin.
They further said that the in such patients strategies to improve the metabolic control should be directed primarily against hyperinsulinaemia by avoiding as much as possible the use of oral secretogogue drugs and of insulin treatment, giving preference to insulin-sensitizers such as metformin and glitazones.
Given that diabetes may be secondary to HCC or to the underlying cirrhosis, and the liver cirrhosis may be caused by diabetes, the researchers believe that further studies involving cirrhotic patients can help evaluate these complex relationships, and particularly whether the diabetes itself has a direct carcinogenetic effect.