Abstract
A tetai of 858 patients (484 males and 374 females), who were admitted for diabetic education at Osaka Prefectural Hospital between 1970 and 1975, were followed up until the end of 1982, and their long-term prognosis and causes of death were studied.
1) Living patients at the end of observation numbered 582 (67.8%), the deceased accounting for 185 (21.6%).
2) The observed numbers of deaths were compared with the expected numbers calculated on the basis of sex-and age-specific mortality rates among the general population of Osaka. The Obs./Exp. ratios of all causes and renal disease were significantly increased in both sexes. The ratios of liver and pancreatic cancer and liver cirrhosis were significantly increased in males. On the other hand, a significantly increased ratio was found for female cardiovascular disease.
3) Next, a case-control study was conducted within this cohort, in order to elucidate risk factors related to deaths from liver cancer and cirrhosis. The case group was 28 diabetic patients with newly developed disease who died of liver cancer or cirrhosis. The control group was selected from living diabetic patients matched for sex, year of admission (±one year) and birth year (±5 years), on the basis of a case to control ratio of 1: 3 or 1: 2.
4) Serum transaminase activities were elevated in 85.7%(24/28) of cases and 29.3%(22/75) of controls. The relative risk was estimated to be 14.5 among diabetic patients with elevated transaminase activities.
5) Alcohol consumption was compared between the two groups. A strong positive association between drinking habits and deaths from liver cancer or cirrhosis was observed, and there was a significant dose-response relationship after adjustment for serum transaminase levels.
6) Neither hepatitis B virus nor blood transfusion was a major risk factor for deaths from liver cancer or cirrhosis among diabetic patiets. Rates of diabetic triopathy were comparable between cases and controls, and oral hypoglycemic agents did not seem to increase the risk of liver cancer or cirrhosis.
The above-mentioned findings may suggest that hepatitis B surface antigen negative hepatitis and alcohol consumption were major independent risk factors related to liver cancer and cirrhosis among diabetic patietns in Japan.
