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Insulin resistance in euglycemic cirrhosis
Amitava Goswami1, Narendra Bhargava1, Sunil Dadhich1
1Department of Gastroenterology, Dr Sampurnanand Medical College, Jodhpur, India.
Annals of Gastroenterology
|July 1, 2014
Summary
Insulin resistance (IR) is common in cirrhosis, with pancreatic beta-cells compensating initially. Advanced liver disease can lead to impaired beta-cell function and hepatogenous diabetes.
Area of Science:
- Hepatology
- Endocrinology
- Metabolic Syndrome
Background:
- Insulin resistance (IR) is linked to hepatic fibrosis and cirrhosis.
- The mechanism of hyperinsulinemia in cirrhosis remains unclear.
- This study investigates hyperinsulinemia and pancreatic beta-cell function in euglycemic cirrhosis.
Purpose of the Study:
- To assess hyperinsulinemia and pancreatic beta-cell function in euglycemic cirrhosis of varied etiology.
- To evaluate the relationship between IR, cirrhosis severity, and beta-cell function.
Main Methods:
- Cross-sectional case-control study of 100 subjects.
- Insulin resistance assessed using Homeostasis Model Assessment (HOMA) and quantitative insulin sensitivity check index.
- Pancreatic beta-cell function evaluated via HOMA-beta in different cirrhosis stages.
Main Results:
- Overall IR observed in 68.5% of euglycemic cirrhosis patients.
- IR prevalence varied by etiology: Hepatitis C (100%), NAFLD (100%), Autoimmune Hepatitis (100%), HCC (80%), Alcoholic Liver Disease (72%), Hepatitis B (45%).
- Elevated HOMA-IR and HOMA-beta correlated with advanced cirrhosis (CTP score >9, MELD score >15). HOMA-beta was significantly higher in euglycemic cases compared to diabetic controls.
Conclusions:
- Insulin resistance is prevalent in euglycemic cirrhosis.
- Compensatory increase in pancreatic beta-cell insulin secretion occurs with advancing liver disease.
- Prolonged IR may lead to impaired beta-cell function and hepatogenous diabetes.
Keywords:
Child Turcotte PughHomeostatic model assessmenthepatocellular carcinomamodel of end stage liver diseasequantitative insulin sensitivity check indexMore Related Videos
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