Liver cirrhosis and diabetes: Risk factors, pathophysiology, clinical implications and management

Abstract

About 30% of patients with cirrhosis have diabetes mellitus (DM). Nowadays, it is a matter for debate whether type 2 DM in the absence of obesity and hypertriglyceridemia may be a risk factor for chronic liver disease. DM, which develops as a complication of cirrhosis, is known as "hepatogenous diabetes". Insulin resistance in muscular and adipose tissues and hyperinsulinemia seem to be the pathophysiologic bases of diabetes in liver disease. An impaired response of the islet beta-cells of the pancreas and hepatic insulin resistance are also contributory factors. Non-alcoholic fatty liver disease, alcoholic cirrhosis, chronic hepatitis C (CHC) and hemochromatosis are more frequently associated with DM. Insulin resistance increases the failure of the response to treatment in patients with CHC and enhances progression of fibrosis. DM in cirrhotic patients may be subclinical. Hepatogenous diabetes is clinically different from that of type 2 DM, since it is less frequently associated with microangiopathy and patients more frequently suffer complications of cirrhosis. DM increases the mortality of cirrhotic patients. Treatment of the diabetes is complex due to liver damage and hepatotoxicity of oral hypoglycemic drugs. This manuscript will review evidence that exists in relation to: type 2 DM alone or as part of the metabolic syndrome in the development of liver disease; factors involved in the genesis of hepatogenous diabetes; the impact of DM on the clinical outcome of liver disease; the management of DM in cirrhotic patients and the role of DM as a risk factor for the occurrence and exacerbation of hepatocellular carcinoma.

Anti–oxidative role of quercetin derived from Allium cepa on aldehyde oxidase (OX–LDL) and hepatocytes apoptosis in streptozotocin–induced diabetic rat

“…On the other hand, liver diseases can induce diabetes mellitus. This type of diabetes mellitus is clinically different from that of type II diabetes mellitus since it is less frequently associated with microangiopathy [16] . Insulin resistance occurs in muscular and adipose tissues combined with hyper insulinemia are pathophysiological bases of diabetes in liver disease [1,16] .…”

“…This type of diabetes mellitus is clinically different from that of type II diabetes mellitus since it is less frequently associated with microangiopathy [16] . Insulin resistance occurs in muscular and adipose tissues combined with hyper insulinemia are pathophysiological bases of diabetes in liver disease [1,16] . The etiology of liver disease is important in the incidence of diabetes mellitus since non alcoholic fatty liver disease (NALFD), alcohol, hepatitis C virus (HCV) and hemachromatosis are frequently associated with diabetes mellitus [16] .…”

“…Other investigations show Quercetin increases the level of blood insulin and serum Ca 2+ and Mg 2+ [15] . Investigations show liver has an important role in carbohydrate metabolism since it is responsible for the balance of blood glucose level by means of glycogen sis and glycogenolysis therefore impaired hepatic function impairs metabolic homeostasis of glucose [1,16] . In the presence of impaired glucose metabolism and occurrence of hyperglycemia, genes involved in fatty acid storage were activated [17] .…”

“…Insulin resistance occurs in muscular and adipose tissues combined with hyper insulinemia are pathophysiological bases of diabetes in liver disease [1,16] . The etiology of liver disease is important in the incidence of diabetes mellitus since non alcoholic fatty liver disease (NALFD), alcohol, hepatitis C virus (HCV) and hemachromatosis are frequently associated with diabetes mellitus [16] . Investigations show liver tissue damage and apoptosis induced by diabetes mellitus increase active O2 specious.…”

“…Flavonoids as an antioxidant factor found in nutrient such as fruit, vegetables, tea and black burgundy grape. Flavonoids value in daily meal varies from 16 mg to 1000 mg. Quercetin as an important and main flavonoids found in human meal. Investigations show Quercetin absorbs in small bowel.…”