Diabetes Mellitus in chronic liver disease

AIM: Frequency of defective glucose metabolism of various degrees and diabetes mellitus (DM) is increased in chronic liver diseases (CLD). Diabetes that develops as a complication of cirrhosis is known as ?hepatogenous diabetes?, however insulin resistence and glucose intolerance is observed in most of the patients even during early stages of CLD. Etiologyand stage of the disease is important for development of hepatogenous diabetes. Moreover, diabetes increases the morbidity and mortality of patients with liver cirrhosis. The aim of this study was to evaluate the relationship of the frequency of diabetes mellitus development with the etiology and severity of disease in chronic liver disease (chronic hepatitis, liver cirrhosis and hepatocellular cancer).MATERIAL AND METHODS: A retrospective study was carried out by investigating the files of patients followed up at the Internal Medicine Department of Celal Bayar University Hospital between January 2007 and July 2010, with the diagnosis of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). One hundred eighty six patients with chronic liver disease (90 chronic hepatitis, 80 cirrhosis and 16 hepatocellular carcinoma) were enrolled in the study excluding the ones with diabetes mellitus and pancreatic disease in their history as well as the ones who had otoimmunity, biliary and nonalcoholic fatty liver disease, hemachromatosis, Wilson and other metabolic diseases in etiology. Fasting blood glucose levels of t he patients were evaluated to determine the state of normoglycemia (NG), impaired fasting glucose (IFG) and DM. Patients were evaluated according to their age, gender, etiology (HBV, HCV, alcohol and cryptogenic) and disease group (chronic hepatisis, liver cirrhosis, hepatocellular carcinoma) and patients with cirrhosis and hepatocellular carcinoma were also grouped according to child-pugh and MELD (Model for End-Stage Liver Disease) scores.RESULTS: Frequencies of diabetes and IFG were 28% and 20.4% respectively in 186 patients with chronic liver disease. It was seen that frequencies of DM and IFG in patients with cirrhosis were statistically significantly higher than those in patients with chronic hepatitis (p=0.004). Distribution of NG, IFG and DM were not detected to be significantly different between patients grouped as A, B, C according to Child or as 14 and below and 15 and above according to the MELD score. (p=0.781, p=0.423). BAG and DM were more found to be more frequent in patients with liver disease due to cryptogenic (67.7%), HCV (56.8%) and alcohol consumption (60%) compared to the cases with liver disease due to HBV (38.9%) (p=0.017).DISCUSSION: Frequencies of impaired glucose metabolism of various degrees and DM are increased in patient with chronic liver disease (CLD). Hepatogenous diabetes which develops as a complication of cirrhosis, accelarates the progression of liver disease and increases the morbidity and mortality. In our study, prevalences of IFG and DM in CLD were higher than the general population in accordance with the previous literature. Similarly, IFG and DM were more frequent in patients with cirrhosis compared to the ones with chronic hepatitis again in concordance with previous literature. At this point, morbidity and mortality may be expected to decrease with early diagnosis and treatment of DM frequently observed in patients with CLD. Importance of etiological causes such as non-alcoholic fatty liver disease, alcohol, hemochromatosis for development of DM in CLD. Recent publications report increased frequency of diabetes in patients with HCV. In our study, increased frequency of DM and IFG were observed in patients with liver disease due to HCV, alcohol and cryptogenic etiology compared to the ones with HBV.KEY WORDS: Diabetes, chronic liver disease, hepatogenous diabetes, cirrhosis.