Effect of transjugular intrahepatic portosystemic shunt on glycometabolism in cirrhosis patients

Abstract

Patients with liver cirrhosis suffer from hyperinsulinemia, hyperglucagonemia and a certain degree of insulin resistance, and portosystemic shunts may be involved in the etiology. A transjugular intrahepatic portosystemic shunt (TIPS) as a treatment for the complications of portal hypertension leads to hemodynamic changes. The objective of the present study is to evaluate whether TIPS can also affect glycometabolism in cirrhosis patients. Forty-six liver cirrhosis patients (experimental group [EG]) without diabetes who underwent TIPS were evaluated. Portal venous pressure (PVP), cardiac output (CO) and blood flow in the shunt (BFS) were measured or calculated before TIPS, after 15 minutes and, finally, after 90 days. Twenty-five liver cirrhosis patients without diabetes and without TIPS were included as the control group (CG). Oral glucose tolerance tests (OGTTs) were carried out at 0, 1, 7, 30 and 90 days after TIPS or after inclusion in the study. Indices related to glycometabolism and liver function, which included biochemical values, were also investigated. PVP changed immediately from 39.43 ± 1.29 cmH(2)O to 21.43 ± 1.42 cmH(2)O and remained stable thereafter. A pronounced increase in CO was observed after TIPS, while BFS did not change significantly. Also, glycosylated hemoglobin A(1c) (HbA(1c)), fasting plasma glucose (FPG), fasting plasma C-peptide (FPC), glucagon-like peptide-1 (GLP-1) and 2-h post-challenge plasma glucose (2 hPG) were non significantly increased after the shunt. Statistically significant hyperinsulinemia and hyperglucagonemia persisted for 90 days after TIPS. In addition, TIPS was followed by an increase in insulin resistance (IR) and β-cell function. Thirty-four patients in the EG and 15 in the CG were diagnosed with diabetes or prediabetes after 90 days. No significant differences in biochemical values were observed 90 days after the shunt. In addition to causing hemodynamic changes, TIPS augments hyperglucagonemia because of increased secretion and decreased clearance of glucagon in the liver, whereas IR deteriorates after the procedure. However, glycemic control does not worsen after TIPS, and the procedure is not associated with a higher risk of diabetes largely because of the simultaneous increase in insulin.