Case Study: Diabetes in a Patient With Cirrhosis

Abstract

J.T. is a 72-year-old man with chronic hepatitis C and Child-Pugh grade A (clinically well-compensated) cirrhosis. He takes propranolol for esophageal variceal bleeding prophylaxis. He had a blood transfusion 25 years ago. Hepatitis C was diagnosed 10 years ago, and cirrhosis was diagnosed by liver biopsy 2 years ago. He does not drink alcohol. He has never been overweight. He has no personal or family history of diabetes. Over the past year, random plasma glucose levels have ranged from 110 to 180 mg/dl. The most recent random glucose was 210 mg/dl. The patient denies polydipsia, polyuria, nocturia, or any other symptoms of hyperglycemia. He weighs 150 lb (BMI 22 kg/m2). Physical examination findings are normal except for mild palmar erythema, spider angiomata on the upper chest, and a palpable spleen tip. Fasting blood glucose was 136 mg/dl, and a hemoglobin A1c (A1C) was 6.3%. Another fasting glucose several weeks later was 128 mg/dl. 1. Does this patient have type 2 diabetes? 2. Should medication be started to treat hyperglycemia? 3. How does the diagnosis of diabetes affect this patient’s prognosis? At first glance, many clinicians might assume this patient has type 2 diabetes. The history is compatible with this diagnosis. However, the absence of classic risk factors for type 2 diabetes and the appearance of new hyperglycemia in the …