Diabetes mellitus and liver dysfunction: Etiologic and therapeutic considerations

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1. 1. A battery of hepatic tests was performed in 380 patients with diabetes to determine the incidence of liver dysfunction and its relationship to etiology of manifest hyperglycemia with glycosuria. 2. 2. One hundred forty-eight of those studied (38.9 per cent) were found to have evidence of liver dysfunction. Of 130 patients with complications, 55.3 per cent had hepatic dysfunction; 30.4 per cent of those without evident complications had abnormal hepatic studies. Gross dietary and insulin insufficiencies were accompanied by liver dysfunction more frequently; age, sex and duration of diabetes had no influence on the frequency of liver involvement. 3. 3. Thirty selected diabetic patients were subjected to needle biopsy of the liver. Of eight with normal hepatic function five had normal livers and two had fatty metamorphosis on histologic examination. Of 22 with liver dysfunction, histologic examination revealed normal tissue in nine instances, fatty metamorphosis in five instances and portal cirrhosis in eight instances. 4. 4. Sixty-five patients with the diabetic syndrome and evidence of hepatic dysfunction have been followed-up for periods of more than twelve months on a hepatic regimen. Correlation of history, physical examination, function studies and therapeutic response suggests hepatic dysfunction was responsible for abnormal carbohydrate metabolism in fifteen patients, liver dysfunction was secondary to diabetes in forty-eight patients and liver disease and diabetes were coincidental in two patients. One patient had diabetes and hepatic dysfunction which were attributed to obesity. 5. 5. Hepatic studies aid in the evaluation of patients with a provisional diagnosis of diabetes mellitus and constitute a good method of periodically evaluating the degree of control of diabetic patients. 6. 6. Liver dysfunction may occasionally produce the diabetic syndrome or be secondary to it. In eleven patients in whom hepatic disease was believed to be the cause of hyperglycemia with glycosuria, hepatic therapy without insulin resulted in improvement in the hepatic dysfunction and carbohydrate disturbance. Of thirty-five clinic patients with liver dysfunction secondary to diabetes, the hepatic abnormality and carbohydrate tolerance improved with hepatic therapy and insulin in thirty.