Kramer JR, Natarajan Y, Dai J, et al. - Findings from this large cohort of patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes (DM) demonstrated a decreased risk of hepatocellular carcinoma (HCC) in relation to metformin use while an elevated risk was observed in relation to use of combination therapy. In such patients, glycemic control can be a biomarker for HCC risk stratification.

• A retrospective cohort study of 85,963 patients with NAFLD and DM; 524 patients developed HCC during a mean of 10.3 years of follow up.

• Most commonly employed treatment choices include metformin monotherapy (19.7%), metformin-sulfonylureas (19.6%), insulin (9.3%), and sulfonylureas monotherapy (13.6%).

• A 20% lower risk of HCC (HR 0.80) was observed in relation to metformin use vs no medication.

• HCC risk was not impacted by insulin (HR 1.02).

• A 1.6-1.7-fold higher risk of HCC was observed in relation to use of insulin in combination with other oral medications.

• A 31% lower risk of HCC (HR 0.69) was noted in relation to adequate glycemic control.