Diabetes Mellitus and Prediabetes in Patients with Hepatocellular Carcinoma in a Tertiary Philippine Hospital


  • Katherine Anne Banal Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Medical City, Pasig City
  • Elizabeth Paz-Pacheco Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Medical City, Pasig City http://orcid.org/0000-0003-0232-890X
  • Vanessa de Villa Center for Liver Disease Management and Transplantation, The Medical City, Pasig City


hepatocellular carcinoma, diabetes mellitus


Background. Diabetes mellitus (DM) has been shown to be associated with an increased risk for hepatocellular carcinoma (HCC). DM and obesity are coexisting conditions that can increase the risk and severity of nonalcoholic fatty liver disease (NAFLD), leading to HCC even in the absence of cirrhosis. With the rising incidence of HCC and DM worldwide, it is important to identify the clinical characteristics of individuals with DM among those with HCC in our local setting.

Objectives. To determine the prevalence of DM among Filipino patients with HCC at our institution, determine their demographic and clinical profile, and compare the characteristics of HCC patients with and without DM.

Methodology. This is a retrospective, analytical, cross-sectional study involving patients with HCC seen at The Medical City’s Center for Liver Disease Management and Transplantation from January 2010 to December 2014. A chart review was conducted and patients were grouped according to the presence or absence of DM. Data on demographics, body mass index (BMI), comorbidities, social and family history, risk factors for liver disease, and laboratory test results were gathered. STATA 12.0 was used for data analysis.

Results. We included 180 patients with HCC in the analysis. The prevalence of type 2 DM and prediabetes was 52.78%. The median age of patients with DM and prediabetes was 65 years, and 58 years for patients without DM (p=0.002). The average BMI was 27.35+4.68 for patients with DM, and 25.04+5.11 for those without DM (p=0.002). Among the patients without DM, 50.59% had hepatitis B virus (HBV) infection compared to 24.21% of patients with DM (p=0.000). Twenty one percent of patients with DM had cryptogenic cirrhosis compared to 8.24% of patients without DM (p=0.016). Patients with DM had a higher proportion of hypertension (66.32% vs 42.35%, p=0.001) and dyslipidemia (48.42% vs 10.59%, p=0.000).

Conclusion. The prevalence of DM and prediabetes among HCC patients is higher in our institution compared to findings from previous studies. HCC patients with DM were older, and had increased BMI, higher proportion of hypertension and dyslipidemia, lower incidence of HBV infection, and higher incidence of cryptogenic cirrhosis.


Download data is not yet available.


International Agency for Research on Cancer, World Health Organization. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012. Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.

Yuen MF, Hou JL, Chutaputti A. Hepatocellular carcinoma in the Asia pacific region. J Gastroenterol Hepatol. 2009;24(3):346-53. https://doi.org/10.1111/j.1440-1746.2009.05784.x

El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365(12):1118-27. https://doi.org/10.1056/nejmra1001683.

El-Serag HB, Tran T, Everheart JE. Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology. 2004;126(2):460-8. https://doi.org/10.1053/j.gastro.2003.10.065.

Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of liver disease in type 2 diabetes and management of patients with diabetes and liver disease. Diabetes Care. 2007; 30(3):734-43. https://doi.org/10.2337/dc06-1539.

Angulo P. Nonalcoholic fatty liver disease. N Engl J Med. 2002; 346(16):1221-31. https://doi.org/10.1056/nejmra011775.

Khan FZ, Perumpail RB, Wong RJ, Ahemed A. Advances in hepatocellular carcinoma: Nonalcoholic steatohepatitis-related hepatocellular carcinoma. World J Hepatol. 2015; 7(18):2155-2161. https://doi.org/10.4254/wjh.v7.i18.2155.

Bhatt HB, Smith RJ. Fatty liver disease in diabetes mellitus. Hepatobiliary Surg Nutr. 2015; 4(2):101-8. https://doi.org/10.3978/j.issn.2304-3881.2015.01.03.

De Lusong MAA, Labio E, Daez L, Gloria V. Non-alcoholic fatty liver disease in the Philippines: Comparable with other nations? World J Gastroenterol. 2008;14(6):913-7. https://doi.org/10.3748/wjg.14.913.

Andrada PLL, Tan H. Prevalence of metabolic syndrome among patients with non-alcoholic fatty liver disease. Phil J Gastroenterol. 2006;2:14-8. Available at: http://www.psgastro.org/assets/files/journals/v2n1/andrada.pdf.

Manuel JJ, Palugod E, Cervantes J, Go-Santi M, Quimpo J, Jasul G. The association of risk factors in the development of non-alcoholic fatty liver disease (NAFLD) in Filipino patients with type 2 diabetes mellitus in a tertiary center. Philipp J Intern Med. 2007;45:135-43. Available at: http://obesity.org.ph/v4/wp-content/uploads/2013/09/ATT00010.pdf.

El-Serag HB, Hampel H, Javadi F. The association between diabetes and hepatocellular carcinoma: A systematic review of epidemiologic evidence. Clin Gastroenterol Hepatol. 2006;4(3):369-80. https://doi.org/10.1016/j.cgh.2005.12.007.

Lucas ZD, Pangan CP, Patal PC, Ong J. The clinical profile of hepatocellular carcinoma patients at the Philippine General Hospital. Philipp J Intern Med. 2009; 47(1):1-9. https://doi.org/10.3860/pjim.v47i1.877.

Daez MLO, Ong JP, Lomboy ARB, Libuit JM, Vicente IMG, Firmalino GC, et al. Demographic profile and treatment outcomes of Filipino patients with hepatocellular carcinoma in a liver tumor registry. Acta Med Philipp. 2014;48(1): 4-8.

Wong SN, Ong JP, Labio MED, Cabahug OT, Daez MLO, Valdellon EV, et al. Hepatitis B infection among adults in the Philippines: A national seroprevalence study. World J Hepatol. 2013; 5(4):214-9. https://doi.org/10.4254/wjh.v5.i4.214.

Peacock JL, Peacock P. Oxford Handbook of Medical Statistics. New York: Oxford University Press Inc. 2011; 58-9.

Hassan MM, Curley SA, Li D, Kaseb A, Davila M, Abdalla EK, et al. Association of diabetes duration and diabetes treatment with the risk of hepatocellular carcinoma. Cancer. 2010;116(8):1938-46. PMCID: PMC4123320. https://doi.org/10.1002/cncr.24982.

Taura N, Ichikawa T, Miyaaki H, Yatsuhashi H, Ishibashi H, Nakao K. Prevalence of type 2 diabetes mellitus in Japanese patients with hepatocellular carcinoma. Exp Ther Med. 2011;2(1):81-4. https://doi.org/10.3892/etm.2010.167.

Jimeno CA, Kho SA, Matawaran BJ, Duante C, Jasul GV. Prevalence of diabetes mellitus and pre-diabetes in the Philippines: A sub-study of the 7th National Nutrition and Health Survey (2008). Philipp J Intern Med. 2015; 53(2):1-8.

Rahman R, Hammoud GM, Almashhrawi AA, Ahmed KT, Ibdah JA. Primary hepatocellular carcinoma and metabolic syndrome: An update. World J Gastrointest Oncol. 2013; 5(9):186-94. https://doi.org/10.4251/wjgo.v5.i9.186.

Zhang H, Gao C, Fang L, Yao S. Increased international normalized ratio level in hepatocellular carcinoma patients with diabetes mellitus. World J Gastroenterol. 2013; 19(15):2395-2403. https://doi.org/10.3748/wjg.v19.i15.2395.

Vigneri P, Frasca F, Sciacca L, Pandini G, Vigneri R. Diabetes and cancer. Endocr Relat Cancer. 2009; 16(4):1103-23. PMID: 19620249. https://doi.org/10.1677/erc-09-0087.

Siegel AB, Lim EA, Wang S, Brubaker W, Hidalgo RD, Goyal A, et al. Diabetes, body mass index and outcomes in hepatocellular carcinoma patients undergoing liver transplantation. Transplantation. 2012; 94(5):539-43. PMCID: PMC3605709. https://doi.org/10.1097/tp.0b013e31825c58ea.

Donadon V, Balbi M, Valent F, Avogaro A. Glycated hemoglobin and antidiabetic strategies as risk factors for hepatocellular carcinoma. World J Gastroenterol. 2010; 16(24):3025-32. https://doi.org/10.3748/wjg.v16.i24.3025.

World Health Organization. WHO NCD Surveillance Strategy. Available from: http://www.who.int/ncd_surveillance/strategy/en/.



How to Cite

Banal, K. A., Paz-Pacheco, E., & de Villa, V. (2017). Diabetes Mellitus and Prediabetes in Patients with Hepatocellular Carcinoma in a Tertiary Philippine Hospital. Journal of the ASEAN Federation of Endocrine Societies, 32(1), 32. Retrieved from https://www.asean-endocrinejournal.org/index.php/JAFES/article/view/356



Original Articles

Most read articles by the same author(s)

1 2 3 4 5 > >>