Title: Glycemic Profile in Chronic Liver Disease

Authors: Dr Shahul Hameed MM, Dr Rashmi KP

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i9.90

Abstract

Liver has a pivotal role in glucose homeostasis and maintaining blood glucose values within strict normal limits. Chronic liver disease results in impaired glucose tolerance and diabetes, resulting in the entity called Hepatogenous Diabetes. The aetiology as well as the severity of hepatocellular dysfunction has a significant effect on carbohydrate metabolism. The reported incidence of glucose intolerance and diabetes in different studies varies from as low as 20% to as high as 80%. As the liver function worsens, diabetes manifests clinically, and thus Hepatogenous diabetes can be considered a marker of advancing liver disease. The underlying mechanisms are ill-understood. The influence of other extraneous factors like infections, old age, medications and other systemic diseases might also influence the glycemic status. Despite these findings, little attention has been paid on understanding the full spectrum of glycemic dysfunction in our population. This study on 169 patients with chronic liver disease was undertaken to clarify the frequency of occurrence of impaired glucose tolerance, with emphasis on the effect of aetiology and severity of liver dysfunction. This study concluded that of all the causes of chronic liver disease, cirrhosis was most frequently associated with impaired glucose tolerance, next being Hepatitis C(compared to Hepatitis B). Higher incidence was also noted in Child Pugh’s A grading of severity, alcoholism and in the male gender patients. However, our study was limited by the lack of liver biopsy in all patients, with the diagnosis of cirrhosis resting on USG findings.

References

  1. 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;30:734-743.
  2. Holstein A, Hinze S, Thiessen E, Plaschke A, Egberts EH. Clinical implications of hepatogenous diabetes in liver cirrhosis.J Gastroenterology Hepatology.2002;17:67-681.
  3. Merli M, Leonetti F, Riggio O, Valeriano V, Ribaudo MC, Strati F, Tisone G, Casciani CU, Capocacaiia L. Glucose intolerance and insulin resistance in cirrhosis are normalized after liver transplantation. Hepatology. 1999; 30:649-654.
  4. Nishida T, Tsuji S, Tsuji M, Arimitsu S, Haruna Y, Imano E,Suzuki M,Kanda T, Kawano S, Hiramitsu N et al.Oral glucose tolerance test predicts prognosis of ppatients with liver cirrhosis. Am J Gastroenterology.2006;101:70-75.
  5. Lecube A, Hernandez C, Genesca J, Esteban JI, Jardi R, Simo R. High prevalence of glucose abnormalities in patients with hepatitis C virus infection: a multi-variate analysis considering the liver inury. Diabetes care.2004;27:1171-1175.
  6. Lindor KD, Angulo P, Keach JC, BAtts KP. Independent predictors of liver fibrosis in patients with non-alcoholic steatohepatitis. Hepatology. 1999;30: 1356-1362.
  7. Angulo P, Keach JC, Batts KP, Lindor KD. Independent predictors of liver fibrosis in patients with non-alcoholic steatohepatitis. Hepatology. 1999;30: 1356-1362.
  8. Romero Gomez M. Insulin resistance and hepatitis C. World Gastroenterology. 2006;12:7075-7080.
  9. Mehta SH, Brancati FL, Sullowski MS, Strathdee SA, Szklo M, Thomas DL. Prevalance of type 2 diabetes among patients with hepatitis C virus infections in the united states. Ann Internal Medicine. 2000; 133:592-599.
  10. Zeinn NN, Abdulkarim AS, Weisner RH, Egan KS, Persing DH. Prevalance of diabetes mellitus in patients with end stage liver cirrhosis due to Hepatitis C, alcohol or cholestatic disease. Hepatology .2000.;32: 209-217.
  11. Wei M, Gibbons LW, Mitchell TL, Kampert JB, Blair SN. Alcohol intake and incidence of type 2 diabetes in men. Diabetes Care. 2000 ;23: 18-22.
  12. Majumdar G, Base J,Neelkantan. Diabetic care in chronic liver disease. Journal of associations of physicians. 24 ;6: 359-366.
  13. Sarkar BS, KK Das, A Banerjee. A cross-sectional study on occurrence of type 2 diabetes among patients admitted with chronic liver diseases in a medical college in Kolkata. Int J Med Public Health. 2013;3:44–47.
  14. Suri KR, Petrides AS, Stanley T, Mathews DE et al. Insulin resistance in cirrhosis: prolonged reduction of hyperinsulinemia normalizes insulin sensitivity. Hepatology.1998; 28: 141-149.
  15. Knobler H, Schihmanter R, Zifroni A, Fenakel G, Schnatter A. Increased risk of type 2 diabetes in non-cirrhotic patients with chronic hepatitis C virus infection. Mayo clinical proc. 2000: 75;355-359.
  16. Kruzynska YT. Carbohydrate metabolism. Textbook of clinical hepatology. Oxford university press.2nd 1999;257.
  17. Daniel K , Podolsky and Kint .Isselbacher. Derangements of Hepatic Metabolism. Fauci, Brounwald, Isselbacker, Wilson, Martin, Kasper. Eds; Harrison’s principles of internal medicine. Mc Graw Hill, 14th edition:1998
  18. Schneeweiss B, Grossinger W, and Ferance petal. Energy metabolism in patients with acute and chronic liver disease. Hepatology. 1990;11:3887.
  19. Foster KJ, Griffith AH, Dewbury K, Price CP, Wright R. Liver disease in patients with diabetes mellitus. Postgraduate Medical Journal.56; 29: 3-28.
  20. Qureshi K, Abrahms GA,. Metabolic liver disease of obesity and role of adipose tissue in the pathogenesis of non alcoholic fatty liver disease. World J of Gastroenterology. 2007; 13: 3540-3553.
  21. Moucari R, Asseah T, Cazals-Hatem D, Voitot H, Boyer N, Ripault MP, Sobesky R, Martinot –Peignoux M, Maylin S, Nicolas-Chanoine MH et al. Insulin Resistance in chronic Hepatitis C: association with genotypes 1 and 4, serum HCV RNA levels and liver fibrosis. Gastroetnerology. 2008; 134: 416-423.
  22. Lecube A, Hernandez C, Genesca J, Simo R. Proinflammatory cytokines, insulin resistance and insulin secretion in chronic hepatitis C patients –a case control study. Diabetes Care. 2006; 29: 1096-1101.
  23. Romero Gomez M, Del Mar Viloria M, Andrade RJ, Salmeron J, Diago M, Fernandez-Rodriguez CM, Corpas R, Cruz M, Grande R, Vasquez L et al. Insulin Resistance impairs sustained response to peg interferon plus ribavarin in chronic hepatitis C patients. Gastroenterology. 2005; 128: 636-641.

Corresponding Author

Dr Rashmi KP

Govt TD Medical College, Alleppey, Kerala