{
  "abstract": "Background Glycaemic management in patients with T2DM and cirrhosis is challenging due to limited options of anti-diabetic agents and the risk of hypoglycaemia. We aimed to determine the association between glycaemic control and clinical outcomes and compare optimal glycaemic targets in individuals with T2DM, with and without cirrhosis.Methods This retrospective study included adult individuals with T2DM, with or without cirrhosis, after excluding individuals with missing demographic data, type 1 diabetes, missing haemoglobin A 1c (HbA1c) records within 1 year, and major adverse cardiovascular events (MACE) before T2DM diagnosis or within 1 year. The primary outcome was MACE and the secondary outcome was all-cause mortality. Restricted cubic spline analysis was used to assess the potential non-linear relationship between time-weighted average HbA1c and the outcomes. Cause-specific hazard ratios (CSHR) and 95% confidence interval (CI) were estimated, treating non-MACE-related death as competing risks. The incidence of hypoglycaemia was also estimated.Results Among 695,549 patients with T2DM, 16,007 (2.3%) had compensated cirrhosis (mean age 68.8 years, 58.5% men) and 3,331 (0.5%) had decompensated cirrhosis (mean age 67.9 years, 59.3% men). HbA 1c level had a linear relationship with risk of MACE in compensated cirrhosis group (p for non-linearity = 0.227, CSHR of per 1% HbA1c increase [95% CI]: 1.09 [1.06-1.12], p <0.001), decompensated cirrhosis group (p for non-linearity = 0.665, CSHR of HbA1c [95% CI]: 1.11 [1.06-1.17], p <0.001) and non-cirrhosis group (p for non-linearity = 0.104, CSHR of HbA1c [95% CI]: 1.09 [1.08-1.09], p <0.001). Patients with HbA1c <7% had a lower incidence of MACE, regardless of cirrhosis status (IDDF2026-ABS-0168 Figure 1. Association between HbA1c levels and risk of MACE (A-C), and 10-year cumulative incidence of patients with different HbA1c levels (D-F)). Besides, HbA1c had a non-linear relationship with all-cause mortality in all patients with or without cirrhosis. Patients with a HbA1c level of 6-7% had the lowest mortality incidence in all patients with or without cirrhosis (IDDF2026-ABS-0168 Figure 2. Association between HbA1c levels and risk of all-cause mortality (A-C), and 10-year cumulative incidence of patients with different HbA1c levels (D-F)). Patients with decompensated cirrhosis had the highest 10-year incidence of hypoglycaemia (IDDF2026-ABS-0168 Figure 3. Incidence of hypoglycaemia in patients without cirrhosis, with compensated cirrhosis, and decompensated cirrhosis).Conclusions HbA 1c <7% works equally well for T2DM patients with or without cirrhosis, as it is associated with a lower risk of MACE and all-cause mortality. Hypoglycaemia needs special caution in cirrhotic patients, given the potential impact of extrahepatic complications and higher risk of mortality.Abstract IDDF2026-ABS-0168 Figure 1Abstract IDDF2026-ABS-0168 Figure 2Abstract IDDF2026-ABS-0168 Figure 3",
  "authors": [
    {
      "affiliations": [
        "Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Mary Yue Wang"
    },
    {
      "affiliations": [
        "Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Sherlot Juan Song"
    },
    {
      "affiliations": [
        "Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Grace Lai-Hung Wong"
    },
    {
      "affiliations": [
        "Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Vincent Wai-Sun Wong"
    },
    {
      "affiliations": [
        "Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Jimmy Che-To Lai"
    },
    {
      "affiliations": [
        "Medical Data Analytic Center, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China"
      ],
      "name": "Terry Cheuk-Fung Yip"
    }
  ],
  "title": "IDDF2026-ABS-0168 Optimal glycemic target for clinical outcomes in individuals with type 2 diabetes mellitus with and without cirrhosis",
  "uid": "ff4d20a7-103b-5192-a998-ffabc6532c8a"
}