Vol. 3, Issue 3 (2017)
Diagnostic significance of diabetes in liver cirrhosis
Author(s): Dr. Seema Mishra
Abstract: Alterations in carbohydrate metabolism are frequently observed in cirrhosis, and approximately 15% to 30% of patients have overt diabetes. The aim of the present study was to examine the clinical implications and the prognostic significance of hepatogenous diabetes in patients with liver cirrhosis. In a retrospective and prospective study in cirrhosis; we analyzed the prognostic significance of diabetes, which was defined as the presence of hyperglycemia and overt glycosuria that in most cases required dietary restrictions or active treatment. The prospective cohort study was conducted in 76 patients with histologically confirmed liver cirrhosis. The examination included a history, determination of basal C-peptide and glycosylated hemoglobin (HbA1c) and, in some cases, a 3 hours oral glucose tolerance test with 100 g glucose. The clinical records of all patients with cirrhosis admitted to Govt City Hospital, Bilaspur and CIMS, Bilaspur for the period 2011 to 2016 were reviewed in 2016 and surviving patients were prospectively followed up until December 2016. Final status could be obtained in 76 (41 with diabetes); 63 were alive at the end of follow-up. The model identified, in sequence, albumin, ascites, age, bilirubin, serum Glucose and platelets as prognostic factors. The larger mortality rate in patients with diabetes was not due to complications of diabetes but to an increased risk of hepatocellular failure. Thus, the presence of diabetes, clinically detectable and often requiring adequate treatment is a risk factor for long-term survival in cirrhosis. Fifty Four percent of patients with liver cirrhosis had manifest diabetes, 41% had impaired glucose tolerance and only 5% had normal glucose tolerance. In most cases, the hepatogenous diabetes was clinically asymptomatic. The prognosis of cirrhotic patients with diabetes is more likely to be negatively affected by the underlying hepatic disease and its complications than by the diabetes. Thus, antihyperglycemic treatment of hepatogenous diabetes should always be carefully weighed up in each individual case.