Impact of diabetes on muscle strength and metabolic profile in cirrhotic patients awaiting liver transplantation

Hepatogenous diabetes (DM) and sarcopenia (reduced muscle strength) are well-known complications of advanced cirrhosis. However, the clinical impact of their co-presence in liver transplant (LT) candidates has not been previously studied.

A single-centre observational study evaluated 119 cirrhotic patients on the LT waiting list to investigate the link between DM and reduced muscle strength, measured with handgrip strength.

Within this cohort, 61.3% of patients had DM and 39.9% had probable sarcopenia. Notably, the prevalence of reduced muscle strength was significantly higher in the DM group compared to the non-DM group (49.3% vs. 30.4%). Regression analysis identified DM as a predictor of reduced handgrip strength (OR 2.72, 95% CI 1.15-6.43; p = 0.022), independently from age. Patients with DM were generally older and had a higher waist circumference. Interestingly, while total daily energy intake was similar between both groups, patients with DM consumed a higher relative percentage of dietary protein.

These findings suggest that diabetes negatively impacts muscle function in cirrhotic patients, likely due to the combined effects of insulin resistance and systemic inflammation. Early identification of this frail phenotype is crucial for implementing targeted nutritional and lifestyle interventions to optimize patient outcomes.