Secular Trend in Glycaemic Management in Type 2 Diabetes Patients With and Without Cirrhosis Between 2000 and 2023: A...

With the change in antidiabetic medications, the trend of glycaemic management is still unclear for type 2 diabetes mellitus (T2DM) patients, especially those with cirrhosis. We aimed to examine secular trends in glycaemic control and antidiabetic medication usage among T2DM patients with or without cirrhosis.

We retrospectively included T2DM adult patients with or without cirrhosis from 2000 to 2023 in Hong Kong, and excluded those with type 1 diabetes. Serial laboratory measurements in each of the five consecutive periods (2000-2004, 2005-2009, 2010-2014, 2015-2019, and 2020-2023) were compared by time-weighted average. The percentages of patients who achieved haemoglobin A_1c (HbA_1c) < 7% and fasting blood glucose < 7.2 mmol/L, as well as the trend of antidiabetic medication usage and hypoglycaemia incidence, were examined.

Of 1,206,233 patients with T2DM (mean age 63.1 years, 52.0% males), 1,143,033 (94.8%), 45,208 (3.7%) and 17,992 (1.5%) had no cirrhosis, compensated and decompensated cirrhosis, respectively. All patients with or without cirrhosis had increasing proportions of patients achieving HbA_1c target over the years, with compensated cirrhosis group having the best control (from 2000-04 to 2020-23: non-cirrhosis group: 39.2% to 65.9%, compensated cirrhosis group: 49.3% to 75.8%, decompensated cirrhosis group: 47.6% to 64.6%). The probability of achieving glycaemic targets increased over time in all groups. Insulin was the predominant agent in decompensated cirrhosis group, with an increasing incidence of hypoglycaemia.

Glycaemic control improved in T2DM patients irrespective of cirrhosis status. Further research is needed to determine the impact of sustained control on hepatic and extrahepatic outcomes.