Title: Impaired Glucose Regulation in Cirrhosis Liver – The Utility of Oral Glucose Tolerance Test
Authors: Dr Kiruthika Kesavan MD, Dr P. Sureshkumar MD
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.90
Abstract
Background and Objectives: Liver is one of the major organs to be involved in carbohydrate metabolism, and hence it is no surprise that chronic liver disease is associated with derangements in glucose metabolism. The objectives of this study is to find out the prevalence and clinical implications of the spectrum of glucose metabolism disorders (IGT/DM) in CLD and assess and compare the prognosis of the disease using the Child-Turcotte-Pugh scoring.
Methods: This study was conducted over a period of six months and included 50 patients. Detailed clinical examination along with biochemical and radiological investigations were carried out. OGTT was then performed in these individuals. Patients who were known diabetics, drugs causing hyperglycemia and pregnant women were excluded from the study.
Results: CLD was much more common in males. There was a significant percentage of IGT/DM diagnosed in these patients using OGTT. The results were, 36%-IGT and 28% DM. It was also proved that as the severity of disease worsened, which was assessed by CTP scoring, the degree of hyperglycemia also increase proportionately. The percentage of impaired glucose regulation in Child class A was 47% , class B 68% and class C 93%
Keywords: Chronic liver disease,oral glucose tolerance test, impaired glucose tolerance, diabetes mellitus.
References
- Kruzyska Y.T. carbohydrate metabolism: Textbook of Clinical Hepatology. Oxford University Press.2 nd 1999; 257.
- Daniel K.Podolsky and Kint J. Isselbacher: Derangements of Hepatic Metabolism Fauci, Brounwald, Isselbacker, Wilson ,Martin, Kasper,eds; Harrison’s principles of Internal Medicine, Mc Graw Hill,14 th ed:1998.
- Schneeweiss B, Grossinger W and Ference Petal: Energy Metabolism in patients with Acute and Chronic liver Disease. Hepatology, 1990 ; 11:387.
- Manson A L, Law J.Y.N and Hoang N:Association of diabetes mellitus and chronic hepatitis C virus infection .Hepatology, 1999:29:3-28.
- Felig P, Brown V, Robert A, Glucose homeostasis in viral hepatitis. New England Journal of Medicine, 1970: 283:26:1436.
- Kruzyska Y.T, Glucose control in liver disease. Current Med.Lit.Gastroenterology 1992;11:9.
- Majumdar G,Base J and Neelakantan, Diabetic state in chronic liver diseases. Journal of Associations of Physicians 24;6:359-366.
- Lund,Schmidt and Decker T,Study of portal and cubital serum Insulin during oral,Portal and Cubital GTT.Acta.Med Scond,1975;197:275-281.
- Naik B K and Narasmha R, Clinical Aspect of cirrhosis of Liver; J.A.P.I;11,10:791-793,1963.
- Sarkar N,Pal J,Dasguptha,Agarwal V,Kyjarwal D,etal :Clinical and Laboratory profile if chronic liver disease ,Paper presentation -88, APICON, API;51;12:2003.
- Mendenhall CL: Alcoholic hepatitis, Clinical gastroenterology, 10;420,1981.
- Brunt PW, Kew MC and Schener JJ studies on Alcoholic Liver Disease in Britain; Clinical and Pathological patterns related to a natural history. Gut; 1974;15:52-58.
- Anklesari, glucose intolerance in Chronic Liver Disease; paper presention in APICON;1974
- Mishra S.S & Mishra R.N, Cirrhosis of Liver incidence, etiology & Natural history in A.P.I;11,10:747-755,1963.
- Hagel S, Bruns T, Schmidt C, Stallmach A. Impaired Oral Glucose tolerance test & Diabetes Mellitus predict hort term prognosis of patient with Liver cirrhosis. Z gastroenterol 2009;47-P5_09. DOI: 10.1055/s-0029-1191971.
- Hagel S, Bruns T, Hermann A, Schmidt C, Stallmach A. Abnormal glucose intolerance: a predictor of 30-day mortality in patients with decompensated Liver cirrhosis. Z Gasteroenterol. 2011 Mar;49 (3): 331-4. DOI:10.1055/s-0029-1245933
- Nishida T, Tsuji S, Tsujii M, Amimitsu S et al . Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis. Am J Gastroenterol. 2006 -Jan;(1):70-5
- Muller MJ, Pirlich M, Balks HJ, Selberg O. Glucose intolerance in liver cirrhosis: role of hepatic and non-hepatic influences. Eur J Clin Chem Clin Biochem. 1994 Oct;32(10):749-58.
- Shankar TP, Solomon SS, Duckworth WC, Himmelstein S, Gray S, Jerkins T, Bobal MA, Iyer RS. Studies of glucose intolerance in cirrhosis of liver. J Lab Clin Med. 1983 Oct;102(4):459-69.
- Elichi Imano, Tsutomu Nishida, Michihiko Shibata, Tsutomu Kanda. Significance of oralglucose tolerance test for the diagnosis of diabetes mellitus in patients with liver cirrhosis. 1999 Nov;38(11):198.