Diabetes Mellitus in Patients With Autoimmune Hepatitis: Frequency, Risk Factors and Effect on Outcome

Area of Science:

• Hepatology
• Endocrinology
• Clinical Medicine

Background:

• Corticosteroids are standard treatment for autoimmune hepatitis (AIH).
• Corticosteroid use is linked to new-onset diabetes mellitus (DM).
• Predisposing factors and outcomes of DM in AIH are not well understood.

Purpose of the Study:

• To determine the frequency of DM in AIH patients.
• To identify factors predisposing AIH patients to DM.
• To assess the association of DM with AIH progression and mortality.

Main Methods:

• A retrospective/prospective single-center study included 494 AIH patients (1987-2023).
• 466 patients received corticosteroids (prednisolone or budesonide).
• Follow-up duration was a median of 9 years.

Main Results:

• 10% of AIH patients had pre-existing DM; 13% developed new-onset DM.
• New-onset DM incidence after 10 years of prednisolone was 14% (14-fold higher than expected).
• Risk factors for new-onset DM included older age, non-Caucasian ethnicity, higher prednisolone dose, higher BMI, and weight gain. New-onset DM predicted all-cause death/transplantation and cirrhosis development.

Conclusions:

• New-onset DM affects 13% of AIH patients and is linked to specific risk factors.
• DM in AIH patients is an independent predictor of mortality/transplantation and cirrhosis.
• Minimizing corticosteroid use in AIH is crucial to reduce DM incidence and improve patient outcomes.