Mortality for Any Hepatic Cause in People With Diabetes Compared to the Non‐Diabetic Population. A 10‐Year‐Observational Study

ABSTRACT Background & Aims The relationship between diabetes and liver disease is increasingly recognised as a significant contributor to mortality. This 10‐year observational study aimed to assess the mortality risk from hepatic causes in people with type 2 diabetes (T2DM) compared to non‐diabetic individuals. Methods Conducted in the Piedmont region of Italy, the study included over 4 million residents aged 35–85, with 100 611 newly diagnosed diabetic patients followed for a median of 6.5 years. Mortality rates due to liver diseases were analysed using standardised mortality rates (SMR), and, in the diabetic population, Poisson regression was used to assess relationships between mortality and clinical variables. Results Diabetic individuals faced a threefold higher risk of liver‐related mortality compared to their non‐diabetic counterparts (9.96 per 10 000 in the diabetic population vs. 3.02 per 10 000). The primary hepatic causes of death were hepatocellular carcinoma and metabolic dysfunction‐associated steatotic liver disease. Key risk factors for increased hepatic mortality included male gender, advanced age, high FIB‐4 scores (indicating liver fibrosis), poor glycemic control (HbA1c > 9%), and a history of alcohol abuse. Notably, antidiabetic treatments, particularly newer therapies like GLP‐1 RAs and SGLT2 inhibitors, were associated with reduced liver mortality. Insulin treatment, however, was linked to higher mortality. Conclusions This study highlights the need for targeted interventions to manage hepatic complications in diabetic patients, focusing on glycemic control, liver fibrosis assessment, and alcohol consumption reduction. The possible beneficial effects of incretins and SGLT2 inhibitors, along with the possible adverse impact of insulin, should be interpreted cautiously, considering the potential influence of reverse causality.