Diabetes and cirrhosis: Current concepts on diagnosis and management

Abstract

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.

Autoimmune liver diseases and diabetes: A propensity score matched analysis and a proportional meta‐analysis

“…48 As pancreatic beta-cell function declines over time, diabetes finally develops. 45,46 As mentioned previously, a lower platelet count has been associated with new onset of diabetes in 118 AIH patients. 33 As a low platelet count is associated with portal hypertension and cirrhosis, 49 this finding could be explained by the presence/development of cirrhosis.…”

“…Chronic hyperinsulinemia is a common feature of cirrhosis, emerging as an adaptive pancreatic beta‐cell response to insulin resistance together with reduced peripheral tissue and hepatic insulin clearance 47 and porto‐systemic shunting 48 . As pancreatic beta‐cell function declines over time, diabetes finally develops 45,46 . As mentioned previously, a lower platelet count has been associated with new onset of diabetes in 118 AIH patients 33 .…”

“…The underlying mechanisms include insulin resistance of the liver, skeletal muscle and adipose tissue together with pancreatic beta‐cell failure (i.e. decreased insulin secretion) 45,46 . Chronic hyperinsulinemia is a common feature of cirrhosis, emerging as an adaptive pancreatic beta‐cell response to insulin resistance together with reduced peripheral tissue and hepatic insulin clearance 47 and porto‐systemic shunting 48 .…”

“…decreased insulin secretion). 45,46 Chronic hyperinsulinemia is a common feature of cirrhosis, emerging as an adaptive pancreatic beta-cell response to insulin resistance together with reduced peripheral tissue and hepatic insulin clearance 47 and porto-systemic shunting. 48 As pancreatic beta-cell function declines over time, diabetes finally develops.…”

Erratum: Diabetes and cirrhosis: Current concepts on diagnosis and management

“…The authors of this article 1 have made changes to improve the readability of the Figures as well as Table 1. An updated PDF of the article is available at [Supplemental Digital Content, http://links.lww.com/HEP/I14].…”