Prediabetes, diabetes mellitus frequency and associated conditions in patients under follow-up for chronic liver disease

The prevalence of diabetes in patients with chronic liver disease is higher compared to normal populations. Cirrhosis patients may have two different types of diabetes; first, type 2 diabetes mellitus (type 2 DM) and second is diabetes known as, hepatogenous diabetes (HD) which is developed secondary to cirrhosis. The incidence of DM in patients with cirrhosis is much more associated with some etiological factors. Diabetes is associated with increased morbidity and mortality in patients with cirrhosis. Additionally, the treatment of diabetic patients with cirrhosis is complex and difficult. In this study, we aimed to evaluate the incidence of diabetes mellitus and prediabetes in patients with chronic liver disease follow-up in the outpatient clinic of Gastroenterology of Akdeniz University Faculty of Medicine. The medical registry of the patients who applied to the Gastroenterology and Hepatology outpatient clinic of Akdeniz University Faculty of Medicine between May 2017 and April 2018 were retrospectively reviewed. Fasting plasma glucose (FPG), HbA1c and OGTT results and, data related to liver disease were examined for the patients who were diagnosed with chronic liver disease by using clinical, laboratory, radiological and pathological methods. Of the 156 patients included in the study, 34% (n= 54) had cirrhosis, 52.5% (n= 85) had chronic B hepatitis and 11.5% (n= 18) had chronic C hepatitis. While 23.1% (n= 36) of the patients had DM, 76.9% (n= 120) did not. Of the 156 patients, 151 (n= 96.8) were seen to have HbA1c results and 120 (53.3%) patients without diabetes diagnosis had OGTT results. The FPG, HbA1c and OGTT results were screened and the percentage of novel DM diagnosis was obtained as 10.8% (n= 13). Of these, 4.3% (n= 5) had a diagnosis of DM by using HbA1c. Nine of 13 patients with novel DM diagnosis had OGTT data. One of these patients was diagnosed via both HbA1c and OGTT with the values HbA1c ≥ 6.5% and OGTT = 126 at 0 h. For other 8 patients, while OGTT met the diagnostic criteria of DM, HbA1c was found to be <6.5%. According to the medical data of the patients having both OGTT and HbA1c values, 1.6% of patients were diagnosed as DM according to HbA1c and 14.3% of patients were diagnosed according to OGTT results. As a result of Mc Nemar analysis, the ratio of patients diagnosed with OGTT (14.3%) was significantly higher than the ratio of patients diagnosed with HbA1c (1.6%) (p <0.05). According to the OGTT results of 55 patients who did not meet the diagnostic criteria of diabetes, 41.8% (n= 23) had prediabetes. The percentage of DM diagnosis was 34% among patients having cirrhosis while that percentage was 38.9% for patients with chronic hepatitis C and 12.9% for patients with chronic hepatitis B. Accordingly, the incidence of DM was higher in patients with cirrhosis and chronic hepatitis C than in patients with chronic hepatitis B (p <0.05). In our study, prevalence of glucose metabolism disorders were found to be increased in patients with chronic liver diseases compared to normal population. When FPG and HbA1c levels were used as standard methods for diabetes diagnosis, some DM patients were noticed to be undiagnosed. In addition, glucose metabolism disorders were shown to be possibly detected at an earlier stage in patients who underwent OGTT. Furthermore, the incidence of DM in patients having liver disease with cirrhosis and chronic hepatitis C etiology was higher than in patients with chronic hepatitis B.