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Epidemiologic links between diabetes and nonalcoholic fatty liver disease (NAFLD) are well established; in turn, NAFLD is a risk factor for hepatocellular carcinoma (HCC), usually mediated by steatohepatitis and cirrhosis. These observations raise the question of whether diabetes control — or specific diabetes medications — might lower risk for HCC.
In a study from the U.S. Veterans Affairs system, researchers identified 86,000 patients diagnosed with both NAFLD and type 2 diabetes between 2004 and 2008. During average follow-up of 10 years, about 500 patients developed HCC. In analyses adjusted for numerous confounding variables, metformin monotherapy, compared with no diabetes treatment, was associated with significantly lower risk for HCC…