Is insulin the preferred treatment in persons with type 2 diabetes and liver cirrhosis?

BMC Gastroenterology

Table 2 Outcomes of insulin users and matched nonusers with diabetes and compensated liver cirrhosis

Outcomes	Non-insulin users (n = 4094)			Insulin users (n = 2047)			Crude HR (95% CI)	p value	Adjusted HR^a (95% CI)	p value
Outcomes	Events	PY	IR	Events	PY	IR	Crude HR (95% CI)	p value	Adjusted HR^a (95% CI)	p value
All-cause mortality	979	24,075	4.07	627	11,866	5.28	1.33 (1.21˗1.48)	< 0.0001	1.31 (1.18˗1.45)	< 0.0001
HCC	700	22,490	3.11	402	10,921	3.68	1.17 (1.03˗1.32)	0.01	1.18 (1.05˗1.34)	0.007
MACE	512	22,227	2.30	339	10,738	3.16	1.37 (1.19˗1.57)	< 0.0001	1.41 (1.23˗1.62)	< 0.0001
Stroke	300	23,086	1.30	186	11,285	1.65	1.28 (1.07˗1.54)	0.007	1.31 (1.09˗1.58)	0.004
Ischemic heart disease	198	23,277	0.85	128	11,394	1.12	1.31 (1.05˗1.64)	0.02	1.36 (1.09˗1.71)	0.006
Heart failure	125	23,649	0.53	128	11,507	1.11	2.11 (1.65˗2.71)	< 0.0001	2.18 (1.70˗2.80)	< 0.0001
Decompensated cirrhosis	642	22,865	2.81	465	10,890	4.27	1.50 (1.33˗1.69)	< 0.0001	1.53 (1.35˗1.72)	< 0.0001
Variceal bleeding	41	23,986	0.17	38	11,767	0.32	1.83 (1.18˗2.85)	0.007	1.81 (1.16˗2.83)	0.009
Hepatic ascites	407	23,381	1.74	327	11,196	2.92	1.66 (1.43˗1.92)	< 0.0001	1.68 (1.45˗1.95)	< 0.0001
Hepatic encephalopathy	351	23,577	1.49	281	11,380	2.47	1.64 (1.40˗1.91)	< 0.0001	1.63 (1.39˗1.91)	< 0.0001
Jaundice	102	23,848	0.43	45	11,757	0.38	0.88 (0.62˗1.25)	0.49	0.90 (0.63˗1.29)	0.58
Hepatic failure	493	23,363	2.11	388	11,230	3.46	1.62 (1.42˗1.85)	< 0.0001	1.26 (1.42˗1.86)	< 0.0001
Hypoglycemia	68	23,893	0.28	107	11,576	0.92	3.26 (2.40˗4.42)	< 0.0001	3.33 (2.45˗4.53)	< 0.0001

PY, person-years; IR, incidence rate, per 100 person-years; HR, hazard ratio; CI, confidence interval; HCC, hepatocellular carcinoma; MACE, major adverse cardiac event, including stroke, ischemic heart disease, and heart failure
^aAdjusted for age, sex, index year, age of diabetes mellitus diagnosis, DM duration (years), antihypertensive drugs (ACE inhibitors, ARBs, β-blockers, calcium-channel blockers, diuretics, other antihypertensive), antidiabetic drugs (metformin, sulfonylureas, meglitinides, TZD, α-glucosidase inhibitor, DPP-4 inhibitors), statin, and aspirin, CCI (0, 1, ≥ 2), DCSI score (0, 1, ≥ 2), HBV and HCV

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