Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2020; 26(23): 3249-3259
Published online Jun 21, 2020. doi: 10.3748/wjg.v26.i23.3249
Medications in type-2 diabetics and their association with liver fibrosis
Mohamed Tausif Siddiqui, Hina Amin, Rajat Garg, Pravallika Chadalavada, Wael Al-Yaman, Rocio Lopez, Amandeep Singh
Mohamed Tausif Siddiqui, Hina Amin, Wael Al-Yaman, Amandeep Singh, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, United States
Rajat Garg, Pravallika Chadalavada, Department of Hospital Medicine, Cleveland Clinic, OH 44195, United States
Rocio Lopez, Department of Quantitative Health Sciences, Cleveland Clinic, OH 44195, United States
Author contributions: Siddiqui MT, Amin H, Al-Yaman W and Singh A were involved in conceptualization, data curation, and project administration; Siddiqui MT, Amin H, Al-Yaman W, Singh A, Chadalvada P and Garg R were involved in writing; Lopez R performed the statistical analysis; all authors were involved in interpretation of the results, reviewing and editing of the draft.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: This was a retrospective study which involved the chart review. Requirement for individual patient consent was waived by the IRB.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at singha4@ccf.org.
STROBE statement: The guidelines of the STROBE Statement have been adopted and implemented.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Amandeep Singh, MD, Attending Doctor, Staff Physician, Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave Suite-A5, Cleveland, OH 44195, United States. singha4@ccf.org
Received: January 31, 2020
Peer-review started: January 31, 2020
First decision: February 27, 2020
Revised: June 6, 2020
Accepted: June 10, 2020
Article in press: June 10, 2020
Published online: June 21, 2020
Abstract
BACKGROUND

The prevalence of nonalcoholic fatty liver disease (NAFLD) is significantly rising worldwide. Type-2 diabetes (T2D) is a major risk factor for NAFLD progression.

AIM

To assess the association of commonly used medications to advanced fibrosis (AF) in patients with biopsy-proven NAFLD and T2D.

METHODS

We used the International Classification of Disease 9th Revision Clinical Modification coding system to identify patients with T2D and included patients who underwent liver biopsy for suspected NAFLD between January 1, 2000 to December 31, 2015. We compared demographics, clinical characteristics, and differences in pattern of medication use in patients who had biopsy-proven AF to those without it. A univariate and multivariate analysis was performed to assess the association of different classes of medication with the presence of AF.

RESULTS

A total of 1183 patients were included in the final analysis, out of which 32% (n = 381) had AF on liver biopsy. Mean age of entire cohort was 52 years and majority were females (65%) and Caucasians (85%). Among patients with AF, 51% were on oral hypoglycemics, 30% were on insulin, 66% were on antihypertensives and 27% were on lipid lowering agents for the median duration of 19 mo, 10 mo, 26 mo, and 24 mo respectively. Medications associated with decreased risk of AF included metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin while the use of furosemide and spironolactone were associated with higher prevalence of AF.

CONCLUSION

In our cohort of T2D with biopsy proven NAFLD, the patients who were receiving metformin, liraglutide, lisinopril, hydrochlorothiazide, atorvastatin and simvastatin were less likely to have AF on biopsy, while patients who were receiving furosemide and spironolactone had a higher likelihood of having AF when they underwent liver biopsy. Future studies are needed to confirm these findings and to establish measures for prevention of NAFLD progression in patients with T2D.

Keywords: Diabetes medications, Anti-lipid medications, Antihypertensive medication, Fatty liver, Advanced fibrosis

Core tip: Prevalence of non-alcoholic fatty liver disease is increasing worldwide. Certain medications such as HMG-CoA reductase inhibitors (statins) and Angiotensin converting enzyme inhibitors have been shown to be associated with reduction in advanced fibrosis in patients with viral hepatitis. Patients with T2D are at a higher risk of developing advanced fibrosis. Given that these patients require lifelong medications to treat type 2 diabetes, we sought to analyze their association with biopsy proven liver fibrosis. We hope that our findings will help researchers in the future explore and design prospective studies to further enhance our understanding of this association.