Lean type 2 diabetes mellitus is an independent predictor of mortality in primary biliary cholangitis

Ting-Ting Yin

doi:10.3748/wjg.v32.i13.115649

Lean type 2 diabetes mellitus is an independent predictor of mortality in primary biliary cholangitis

2026-04-07

0

PRE

AI

T

Ting-Ting Yin

H

Huiying Lin

M

Min Zhou

J

Jian-Wei Li

Q

Qiu-Lan Mo

H

Hong-Jing Wang

J

Jie Chen

Z

Zhu, Hui-Ling

Y

Yu-Ting Li

Z

Zheng, Meng-Yao

J

Jin-Hui Yang *

DOI：10.3748/wjg.v32.i13.115649

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BACKGROUND The impact of lean type 2 diabetes mellitus (T2DM) on the prognosis of patients with primary biliary cholangitis (PBC) remains unclear. AIM To explore the adverse prognostic impact of lean T2DM on liver-related mortality risk in patients with PBC. METHODS This retrospective cohort study of 877 PBC patients stratified by T2DM status and lean phenotype used Cox regression models to analyze liver-related outcomes. Interaction effect models investigated T2DM and lean phenotype synergy. Propensity score matching (1:1) controlled for confounders between lean T2DM and non-T2DM non-lean groups, with sensitivity analyses validating results. RESULTS The median age of patients was 57 years (50-66), with 716 (81.64%) being female, and median follow-up was 45 months (25-48), during which 234 deaths (26.68%) occurred. After fully adjusting for confounding factors, lean T2DM remained an independent mortality risk factor in PBC patients [hazard ratio (HR) = 1.845, 95% confidence interval: 1.219-2.793, P = 0.004]. Interaction effect analysis confirmed a significant synergistic effect of T2DM and lean phenotype on mortality risk (interaction term HR = 2.546, 95% confidence interval: 1.342-4.831, P = 0.004). Stratified analysis further substantiated that T2DM significantly increased mortality risk only in lean patients (HR = 2.331, P < 0.001), while lean phenotype elevated risk only among T2DM patients (HR = 2.165, P = 0.0078). Propensity score matching validated this association (HR = 1.63, P = 0.008), with sensitivity analyses confirming the robustness of the conclusions. CONCLUSION Lean T2DM is an independent risk factor for liver-related adverse outcomes in PBC patients, and the coexistence of T2DM and lean phenotype exhibits a significant synergistic effect on mortality risk.

Keywords:

Diabetes mellitus

Lean body weight

Nutritional status

Primary biliary cholangitis

Prognosis

Lean type 2 diabetes mellitus is an independent predictor of mortality in primary biliary cholangitis

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