Hepatogenous Diabetes - A Report from Central India

Area of Science:

• Hepatology
• Endocrinology
• Gastroenterology

Background:

• Cirrhosis leads to liver dysfunction, portal hypertension, and pancreatic beta-cell issues, causing hepatogenous diabetes (HD).
• HD is often overlooked, especially in regions with high chronic liver disease (CLD) and diabetes prevalence.
• This study investigates HD prevalence and its link to cirrhosis severity.

Purpose of the Study:

• To determine the prevalence of hepatogenous diabetes (HD) in patients with cirrhosis.
• To explore the association between HD and the severity of liver cirrhosis.
• To evaluate the diagnostic utility of standard glucose tests versus oral glucose tolerance tests (OGTT) for HD detection.

Main Methods:

• A prospective cross-sectional study included 121 cirrhotic patients without prior diabetes history.
• Oral glucose tolerance test (OGTT) and fasting serum insulin were performed to assess glucose metabolism and insulin resistance (IR) via HOMA-IR.
• Upper gastrointestinal endoscopy was used to identify esophageal varices, and patients were categorized into HD and non-HD groups.

Main Results:

• Hepatogenous diabetes (HD) was diagnosed in 42.98% of patients, with 63.4% missed by fasting plasma glucose (FPG) levels.
• Impaired glucose tolerance (IGT) was observed in 47.93% of patients.
• The HD group exhibited significantly higher MELD scores, HOMA-IR, and increased incidence of large varices, variceal bleeding, and hepatocellular carcinoma (HCC).

Conclusions:

• Cirrhosis patients demonstrate high rates of IGT, IR, and HD, often missed by FPG and HbA1c.
• HD is significantly associated with markers of advanced cirrhosis, including high MELD and CTP scores, bilirubin levels, varices, and HCC.
• OGTT is crucial for diagnosing HD in cirrhotic patients, as standard tests are unreliable.