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

Coman, Laurenţiu; Coman, Oana Andreia; Bădărău, Ioana Anca; Păunescu, Horia; Ciocîrlan, Mihai

doi:10.3390/jcm10020262

Cited by 27 publications

(26 citation statements)

References 80 publications

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“…Although about 30% of patients with cirrhosis have diabetes mellitus (DM) [21], it is not mediated through insulin resistance triggered by obesity. Instead, patients with cirrhosis have a tendency towards malnutrition and cachexia but can develop DM from different metabolic pathophysiologic alterations [22]. Nevertheless, the tendency towards emaciation through sarcopenia [23,24] and the cachexia of the cirrhotic patient was the reason for stratifying data in our research by the BMI of patients involved.…”

Section: Discussionmentioning

confidence: 96%

Laboratory Profile of COVID-19 Patients with Hepatitis C-Related Liver Cirrhosis

Cerbu

Grigoraş

Bratosin

et al. 2022

JCM

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Patients with cirrhosis are known to have multiple comorbidities and impaired organ system functioning due to alterations caused by chronic liver failure. In the past two years, since the COVID-19 pandemic started, several studies have described the affinity of SARS-CoV-2 with the liver and biliary cells. Considering hepatitis C as a significant independent factor for cirrhosis in Romania, this research was built on the premises that this certain group of patients is susceptible to alterations of their serum parameters that are yet to be described, which might be useful in the management of COVID-19 in these individuals. A retrospective cohort study was developed at a tertiary hospital for infectious disease in Romania, which included a total of 242 patients with hepatitis C cirrhosis across two years, out of which 46 patients were infected with SARS-CoV-2. Stratification by patient weight and COVID-19 status identified several important laboratory serum tests as predictors for acute-on-chronic liver failure and risk for intensive care unit admission. Thus, white blood cell count, lymphocyte count, ferritin, hypoglycemia, prothrombin time, and HCV viral load were independent risk factors for ACLF in patients with COVID-19. High PT, creatinine, BUN, and HCV viral load were the strongest predictors for ICU admission. Inflammatory markers and parameters of gas exchange were also observed as risk factors for ACLF and ICU admission, including procalcitonin, CRP, IL-6, and D-dimers. Our study questions and confirms the health impact of COVID-19 on patients with cirrhosis and whether their laboratory profile significantly changes due to SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 96%

Laboratory Profile of COVID-19 Patients with Hepatitis C-Related Liver Cirrhosis

Cerbu

Grigoraş

Bratosin

et al. 2022

JCM

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“…CLD as a “cause” for diabetes, or “hepatogenous diabetes,” has been proposed by some as a unique entity, when altered liver function in cirrhosis presents with hyperinsulinemia and often near-normal (or normal) fasting plasma glucose (FPG) or glycosylated hemoglobin (A1c), but an abnormal response to an oral glucose tolerance test (OGTT) 63,64. Hyperinsulinemia in cirrhosis was recognized already in early studies,56 and now clearly established as secondary to the combined effect of severe insulin resistance and reduced peripheral tissue (largely muscle) insulin clearance.…”

Section: Pathophysiology: Interactions Between Diabetes and Cirrhosismentioning

confidence: 99%

Diabetes and cirrhosis: Current concepts on diagnosis and management

Castéra

Cusi

2023

Hepatology

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Type 2 diabetes mellitus is often associated with cirrhosis as comorbidities, acute illness, medications, and other conditions profoundly alter glucose metabolism. Both conditions are closely related in NAFLD, the leading cause of chronic liver disease, and given its rising burden worldwide, management of type 2 diabetes mellitus in cirrhosis will be an increasingly common dilemma. Having diabetes increases cirrhosis-related complications, including HCC as well as overall mortality. In the absence of effective treatments for cirrhosis, patients with type 2 diabetes mellitus should be systematically screened as early as possible for NAFLD-related fibrosis/cirrhosis using noninvasive tools, starting with a FIB-4 index followed by transient elastography, if available. In people with cirrhosis, an early diagnosis of diabetes is critical for an optimal management strategy (ie, nutritional goals, and glycemic targets). Diagnosis of diabetes may be missed if based on A1C in patients with cirrhosis and impaired liver function (Child-Pugh B–C) as anemia may turn the test unreliable. Clinicians must also become aware of their high risk of hypoglycemia, especially in decompensated cirrhosis where insulin is the only therapy. Care should be within multidisciplinary teams (nutritionists, obesity management teams, endocrinologists, hepatologists, and others) and take advantage of novel glucose-monitoring devices. Clinicians should become familiar with the safety and efficacy of diabetes medications for patients with advanced fibrosis and compensated cirrhosis. Management is conditioned by whether the patient has either compensated or decompensated cirrhosis. This review gives an update on the complex relationship between cirrhosis and type 2 diabetes mellitus, with a focus on its diagnosis and treatment, and highlights knowledge gaps and future directions.

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“…The association between T2DM and liver has been recognized for over 30 years [25]. In patients with T2DM, liver damage can range from fatty liver disease/metabolic associated fatty liver disease, non-alcoholic steatohepatitis, and hepatocellular carcinoma to liver failure [26]. In addition to T2DM, T1DM can lead to liver complications, such as glycogenic liver disease and diabetic hepatosclerosis, recently described as a non-cirrhotic form of hepatic microangiopathy [27,28].…”

Section: Discussionmentioning

confidence: 99%

In Vitro and In Ovo Evaluation of the Potential Hepatoprotective Effect of Metformin

et al. 2022

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Background and Objectives: Metformin is currently the leading drug of choice for treating type 2 diabetes mellitus, being one of the most widely used drugs worldwide. The beneficial effects of Metformin, however, extend far beyond the reduction of blood glucose. Therefore, this study aimed to evaluate Metformin’s effects both in vitro and in ovo. Materials and Methods: Metformin has been tested in five different concentrations in human hepatocytes —HepaRG, in terms of cell viability, morphology, structure and number of nuclei and mitochondria, as well as the effect on cell migration. Through the application of HET-CAM, the biocompatibility and potential anti-irritant, as well as protective effects on the vascular plexus were also assessed. Results: According to the results obtained, Metformin increases cell viability without causing morphological changes to cells, mitochondria, or nuclei. Metformin displayed an anti-irritant activity rather than causing irritation at the level of the vascular plexus. Conclusions: In conclusion, Metformin enhances cell viability and proliferation and, has a protective effect on the vascular plexus. Nonetheless, more studies are required to clarify the mechanism of hepatoprotective effect of metformin.

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

Cited by 27 publications

References 80 publications

Laboratory Profile of COVID-19 Patients with Hepatitis C-Related Liver Cirrhosis

Laboratory Profile of COVID-19 Patients with Hepatitis C-Related Liver Cirrhosis

Diabetes and cirrhosis: Current concepts on diagnosis and management

In Vitro and In Ovo Evaluation of the Potential Hepatoprotective Effect of Metformin

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