Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes.

Laura I Coman,Oana A Coman,Ioana A Bădărău,Horia Păunescu,Mihai Ciocîrlan

doi:10.3390/jcm10020262

Abstract

Background: Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. A particular and yet unrecognized entity is hepatogenous diabetes (HD), defined as impaired glucose regulation caused by altered liver function following LC. Numerous studies have shown that DM could negatively influence liver-related outcomes. Aim: We aimed to investigate whether patients with LC and DM are at higher risk for hepatic encephalopathy (HE), variceal hemorrhage (VH), infections and hepatocellular carcinoma (HCC). The impact of DM on liver transplant (LT) outcomes was also addressed. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases. Population-based observational studies reporting liver outcomes in patients with LC were included. Results: Diabetics are at higher risk for HE, including post-transjugular intrahepatic portosystemic shunt HE. DM also increases the risk of VH and contributes to elevated portal pressure and variceal re-bleeding, while uncontrolled DM is associated with increased risk of bacterial infections. DM also increases the risk of HCC and contributes to adverse LT outcomes. Conclusions: Patients with DM and LC may benefit from close follow-up in order to reduce readmissions and mortality. Due to the heterogeneity of available research, prospective multicenter clinical trials are needed to further validate these findings.

Highlights

Type 2 diabetes mellitus (T2DM), a disorder of glucidic metabolism mainly accompanied by hyperglycemia and insulin resistance (IR), is largely associated with liver cirrhosis (LC)
Liver involvement in T2DM is well recognized in the form of non-alcoholic fatty liver disease/metabolic associated fatty liver disease (NAFLD/MAFLD), which can range from simple steatosis to non-alcoholic steatohepatitis (NASH) and Liver cirrhosis (LC), with or without hepatocellular carcinoma (HCC) or liver failure as indications for liver transplantation (LT) [5]
hepatogenous diabetes (HD) is defined as the development of dysglycemia and impaired insulin regulation following long-term evolution of LC

Summary

Introduction

Type 2 diabetes mellitus (T2DM), a disorder of glucidic metabolism mainly accompanied by hyperglycemia and insulin resistance (IR), is largely associated with liver cirrhosis (LC). Type 1 diabetes mellitus (T1DM), an insulino-dependent disease, might involve hepatic dysfunction [3,4]. Liver involvement in T2DM is well recognized in the form of non-alcoholic fatty liver disease/metabolic associated fatty liver disease (NAFLD/MAFLD), which can range from simple steatosis to non-alcoholic steatohepatitis (NASH) and LC, with or without hepatocellular carcinoma (HCC) or liver failure as indications for liver transplantation (LT) [5]. Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases

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