[Liver cirrhosis in diabetes mellitus; a complication not always recognized]

Non-alcoholic fatty liver disease is common among diabetic patients and carries the risk of non-alcoholic steatohepatitis (NASH) and progressive fibrosis and cirrhosis. This is illustrated by three patients with diabetes mellitus, two women aged 76 and 59, and a man aged 58. The first patient was referred to our clinic with ascites that appeared to be due to a previously unrecognized NASH associated with diabetes and which resulted in liver cirrhosis. She was treated with diuretics and subsequently remained stable. The male patient, suffering from overweight, had silently developed liver cirrhosis prompting referral to a transplantation centre. For this procedure he was put on a weight reduction programme. The third patient also had diabetes-associated liver cirrhosis, but was referred for transplantation when liver failure became inevitable. Because of the increasing prevalence of overweight and diabetes, there will be an increase in the number of patients with diabetes associated NASH and liver failure requiring transplantation.