South Korea: Blood Sugar Variability and Hepatocellular Carcinoma Risk

A recent study published in the journal Cancer Epidemiology, Biomarkers & Prevention finds that blood sugar variability (GV) can independently predict hepatocellular carcinoma (HCC) in diabetes patients. The researchers discovered a linear relationship between blood sugar increase and HCC prevalence, suggesting that visit-to-visit blood sugar monitoring might be helpful for identifying diabetic patients at high HCC risk.

Although diabetes is a well-known risk factor for hepatocellular carcinoma (HCC), exactly which metabolic parameters of diabetes are associated with HCC remains unexplored.

Jeong-ju Yoo, from the Department of Internal Medicine at Soonchunhyang University Bucheon Hospital, South Korea, and colleagues aimed to investigate the relationship between blood sugar variability and HCC in diabetes patients.

For this purpose, the researchers conducted a nationwide population-based study. It included 674,178 diabetes patients who participated in more than three health examinations within five years from the index year (2009-2010). They were followed until the end of 2017.

The coefficient of variation, standard deviation, variability independent of the mean, and average real variability were calculated as GV indices.

Key Findings of the Study

• During a median follow-up of 6.7 years, there were 5,494 cases of HCC.
• When classified into groups according to glucose level, the highest risk for HCC was observed when the basal blood glucose level was 180 mg/dL or greater [adjusted hazard ratio (aHR) 1.19].
• The researchers observed increasing trends for the relationship between GV and HCC in multivariable Cox proportional analyses.
• The risk of HCC increased by 27% (aHR 1.27) for the highest quartile of GV relative to the lowest quartile.
• These findings were consistent regardless of the presence of chronic viral hepatitis or cirrhosis, alcohol consumption, or body mass index.

"GV is an independent predictor of HCC, even after adjusting for confounding factors. There was a linear relationship between increase in GV and prevalence of HCC. Visit-to-visit GV might be helpful for identifying diabetic patients at high risk of HCC," wrote the authors.

The study titled, "Glucose variability and risk of hepatocellular carcinoma in diabetic patients: A nationwide population-based study," is published in the journal Cancer Epidemiology, Biomarkers & Prevention.

DOI: https://cebp.aacrjournals.org/content/early/2021/03/02/1055-9965.EPI-20-1654