Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2025; 16(7): 107256
Published online Jul 15, 2025. doi: 10.4239/wjd.v16.i7.107256
Chronic hepatitis B with type 2 diabetes mellitus: Association between glycemic control and liver fibrosis
Yan Luo, Rui Li, Jun Kang, Ben-Nan Zhao, Li-Juan Lan, Feng-Jiao Gao, Xiao-Xia Ren, Yan-Feng Zhu, Da-Feng Liu
Yan Luo, Yan-Feng Zhu, School of Public Health, Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Rui Li, Jun Kang, Feng-Jiao Gao, Xiao-Xia Ren, Da-Feng Liu, The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu 610066, Sichuan Province, China
Ben-Nan Zhao, Li-Juan Lan, Department of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu 610066, Sichuan Province, China
Co-first authors: Yan Luo and Rui Li.
Co-corresponding authors: Yan-Feng Zhu and Da-Feng Liu.
Author contributions: Luo Y and Li R contributed equally to this manuscript as co-first authors. Luo Y and Liu DF designed the research study; Zhu YF and Liu DF supervised the study and made equal contributions as co-corresponding authors. Luo Y, Li R, Kang J, Zhao BN, Lan LJ, Gao FJ, Ren XX, Zhu YF, and Liu DF acquired the data, analyzed and interpreted the data, drafted the manuscript, provided administrative, technical, or material support. All authors approved the final manuscript.
Supported by Natural Science Foundation of Sichuan Province, No. 2023NSFSC0682.
Institutional review board statement: This study was approved by the Ethics Committee of the Public Health Clinical Center of Chengdu, No. YJ-K2024-15-01.
Informed consent statement: As this is a retrospective study and the majority of patients could not be contacted, the requirement of written informed consent was waived by the hospital ethics committee.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All the data, models, or codes generated or used during the study are available from the corresponding author by request corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Da-Feng Liu, MD, PhD, Chief Physician, Professor, The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, No. 18 Jingjushi Road, Jinjiang District, Chengdu 610066, Sichuan Province, China. ldf312@126.com
Received: March 20, 2025
Revised: April 30, 2025
Accepted: June 16, 2025
Published online: July 15, 2025
Processing time: 118 Days and 2.9 Hours
Abstract
BACKGROUND

The interplay between abnormal glucose metabolism and the progression of liver fibrosis in patients with both chronic hepatitis B (CHB) and type 2 diabetes mellitus (T2DM) remains unclear. Previous studies have suggested that the coexistence of these conditions may exacerbate liver inflammation and fibrosis; however, the impacts of dynamic changes in glucose metabolism indicators, hypoglycemic medication regimens, and glycemic control status on liver fibrosis require further elucidation.

AIM

To explore the effect of glycemic control on hepatic fibrosis in patients with CHB and T2DM.

METHODS

A total of 420 patients with CHB and T2DM admitted to the Public Health Clinical Center of Chengdu between October 2018 and January 2022 were retrospectively included and classified according to liver stiffness measurement and glycemic control for between-group comparisons.

RESULTS

Significant differences were observed in the alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, AST/ALT ratio, total bilirubin, direct bilirubin, diabetes treatment program, and thrombin time values among the liver fibrosis groups (adjusted P < 0.05). Significant differences in albumin and gamma-glutamyl transferase levels were observed among the groups categorized by glucose status at admission (adjusted P < 0.05). A positive correlation between fasting plasma glucose (FPG) and liver stiffness measurement was found to be mediated by ALT and AST. Fibrinogen and the international normalized ratio were positively correlated with glycated hemoglobin A1c, while the fibrosis-4 score, ALT, AST/ALT ratio, type III procollagen N-terminal peptide, ferritin, and activated partial thromboplastin time were correlated with FPG at admission. Additionally, AST was positively correlated with FPG at discharge (P < 0.05).

CONCLUSION

Specific glucose metabolic parameters, hypoglycemic agents, and glycemic control status markers are associated with hepatic fibrosis in patients with both CHB and T2DM. Close blood glucose monitoring, optimized use of hypoglycemic agents, and continuous maintenance of good glycemic control may slow the progression of liver fibrosis in patients with CHB and T2DM.

Keywords: Chronic hepatitis B; Type 2 diabetes mellitus; Liver fibrosis; Hypoglycemic agents; Glycemic control status

Core Tip: This study found that fasting blood glucose significantly mediated the progression of hepatic fibrosis in patients with both chronic hepatitis B and type 2 diabetes mellitus, via the alanine aminotransferase/aspartate aminotransferase pathway. Albumin and gamma-glutamyl transferase levels varied among groups with differing glycemic status, while fibrinogen, the international normalized ratio, serum ferritin, type III procollagen N-terminal peptide, aspartate aminotransferase, prothrombin time, and thromboplastin activity were associated with glycemic levels. These findings indicate that both hepatic impairment and coagulation dysfunction are influenced by glycemic control, and that stringent glycemic management along with the administration of hypoglycemic agents may lower the risk of fibrosis.