Prevalence of glucose intolerance in cirrhotics and risk factors predicting its progression to diabetes mellitus

Abstract

Background: Liver cirrhosis is a unique clinical entity wherein long-standing diabetes mellitus (DM) can predispose an individual to cirrhosis, and on the other hand, a long-standing cirrhosis liver can predispose a cirrhotic to DM, secondary to deranged glucose and insulin metabolism. Aim of the Study: The aim of this study is to determine the prevalence of impaired glucose tolerance (IGT) in patients with liver cirrhosis and risk factors predicting these patients to progression to DM. Materials and Methods: Adult patients above 18 years of age, with a diagnosis of cirrhosis of liver, irrespective of the diabetic status, the aetiology and severity of liver disease, were enrolled for the prospective cross-sectional study. The American Diabetes Association guidelines were followed for classification of DM. Fasting serum insulin assay was done for calculation of homeostatic model assessment insulin resistance (HOMA-IR) with a cut-off of >2.5. Patients with normal baseline glucose tolerance test (GTT) or IGT were followed up prospectively for 6 months at 3 monthly interval. Appropriate statistical tests were applied. Results: Of the 505 cirrhotic patients screened, 158 patients fulfilled the selection criteria. The overall mean age of these 158 patients was 53.3 ± 11.5 years; majority were men (93.7%). As a significant proportion of patients belonged to Child-Turcotte-Pugh (CTP)-C (51.3%) followed by CTP-B and CTP-A. Seventy-four patients had self-reported diabetes (46.8%) at registration. Post-GTT, the prevalence of impaired IGT was 27.4%, and new-onset diabetes mellitus (NODM) was 11.9%. Patients with CTP-C were at greatest risk for either IGT or NODM (P < 0.05). IGT+NODM patients had high median values of 2-h GTT, fasting serum insulin and HOMA-IR compared to non-diabetic participants at admission with a significant trend increase at 3 and 6 months. Conclusion: The prevalence of glucose intolerance is significantly high in individuals with cirrhosis. A 2-h GGT unmasks a significant number of cirrhosis with normal fasting blood sugar and glycated haemoglobin. A trend towards an increase in glucose intolerance and insulin resistance is noted with increasing duration of illness.