Diabetes and Impaired Glucose Tolerance in Liver Patients

Disruption in carbohydrate metabolism is quite common in patients with cirrhosis. Disturbances in glucose metabolism in cirrhotic patients have been frequently discussed in references and articles, particularly regarding fasting and food consumption.

Prevalence of Diabetes and Glucose Tolerance Disorders: The prevalence of diabetes and glucose intolerance in these patients varies widely. In fact, laboratory methods and diagnostic criteria for glucose metabolism disorders in various studies have not been uniform, and these criteria have been revised several times in recent decades. This article examines diabetes and glucose disorders in liver patients.

Liver Disease and Glucose Tolerance: Many studies examining the relationship between liver disease and glucose tolerance have noted that several potential factors influencing the onset of diabetes, which could be considered intervening factors, have not been addressed. In this study, we examine the prevalence of diabetes and glucose intolerance in patients with chronic liver disease using the latest diagnostic criteria. The independent relationship between chronic liver disease and diabetes, considering other potential risk factors for diabetes, is also explored. Additionally, this study investigates factors specifically related to the onset of diabetes in liver patients.

Onset of Diabetes: Before or After Liver Disease? Since both diabetes and chronic liver disease are often asymptomatic until advanced stages, it is generally difficult to determine whether:

• Diabetes onset occurs before or after liver disease?

Researchers have gathered information showing that, in some patients, diabetes is diagnosed either simultaneously with or after cirrhosis.

Importance and Necessity of Screening: The prevalence of diabetes in cirrhosis and chronic hepatitis groups is significantly related to the severity of liver disease. This finding suggests that liver fibrosis, rather than necessarily cirrhosis, may initiate the process of glucose intolerance. It’s interesting to note that although the exact mechanism of glucose intolerance in cirrhosis is not yet fully understood, insulin resistance and reduced receptor sensitivity have been observed.

Insulin Resistance: Insulin resistance is observed in the early stages of chronic hepatitis. Another study examining chronic hepatitis patients with normal glucose tolerance showed a strong correlation between insulin resistance and the degree of fibrosis.

Chronic Hepatitis as an Independent Factor for Diabetes: All these findings confirm that chronic hepatitis is an independent factor for diabetes, and the development of diabetes in these patients is related to the severity of liver disease.

Diabetes and Liver Disease: This study did not find a relationship between diabetes and the cause of liver disease. Some studies have reported a correlation between Hepatitis C infection and higher rates of diabetes, but these findings are not yet definitive. A retrospective study involving 1,117 patients with chronic HCV hepatitis found a relatively strong relationship between diabetes and HCV infection. This study suggested that, independent of its role in chronic liver disease, HCV may play an important role in the onset of diabetes. However, there are also studies presenting findings contrary to this conclusion.

Development of Diabetes in Cirrhotic Patients: The prevalence of diabetes in cirrhosis patients caused by Hepatitis C was significantly higher than in those with cholestatic liver disease. However, there was no significant difference in the rate of diabetes in Hepatitis C cirrhosis patients compared to alcohol-related cirrhosis patients. This suggests that the development of diabetes in cirrhotic patients is closely related to the underlying cause of liver disease. A study did not find a correlation between the cause of liver disease and diabetes in either the cirrhosis or chronic hepatitis groups. However, future studies will likely provide more insights into the relationship between diabetes and the underlying liver disease.

BMI as an Independent Variable: In patients with chronic hepatitis, BMI was identified as an independent variable related to diabetes. Some studies have shown that obesity may be a potential risk factor for liver fibrosis in chronic hepatitis. However, our study found that high BMI may play a distinct role in the pathogenesis of diabetes in chronic hepatitis, independent of liver fibrosis. Furthermore, serum lipids, including plasma free fatty acids and glycerol concentrations, were found to be higher in diabetic cirrhotic patients.

Family History as a Factor in Diabetes: Family history of diabetes is a well-known risk factor. Our study showed that even when the variable of family history of diabetes was included in the regression model, the relationship between cirrhosis and chronic hepatitis with diabetes remained significant. Other studies have confirmed this result, suggesting that liver injury in chronic liver disease is an independent risk factor for diabetes, with family history only acting as a secondary factor.

Age as a Risk Factor for Type 2 Diabetes: Age is a well-known risk factor for Type 2 diabetes, and it was expected that this would also be true for chronic liver disease patients. However, the relative risk of cirrhosis and chronic hepatitis was found to be higher than that of age, indicating a stronger relationship between liver disease and diabetes.

Onset of Diabetes During Interferon Treatment: Some studies have previously reported the onset of diabetes during interferon treatment, but evidence is still lacking. In our study, interferon treatment did not significantly affect the prevalence of diabetes.

Conclusion: Overall, the results indicate a relatively high prevalence of diabetes in patients with chronic liver disease. Given that a significant number of these patients are unaware of their condition, regular screening is highly recommended. For advanced cases, shorter intervals for screening should be considered due to the higher risk of developing diabetes. Weight reduction in chronic hepatitis patients could potentially prevent the onset of diabetes, and doctors should advise these patients to engage in continuous weight reduction measures. Based on the findings of this study, further research should focus on identifying the pathophysiology of diabetes in chronic liver disease patients and the role of viral hepatitis and liver disease severity in the development of diabetes and possibly insulin resistance.

References:

• Alavian S M, Hajarezadeh B, Nematizadeh F, Larijani B. DIABETES AND IMPAIRED GLUCOSE TOLERANCE IN CHRONIC LIVER DISEASE. ijdld 2004; 3 (1): 57-70.