[Differential diagnosis of diabetes mellitus caused by liver cirrhosis and other type 2 diabetes mellitus]

Abstract

Background/aim: The liver plays important roles in the homeostasis of glucose metabolism since it acts as a major target organ for insulin and a site for gluconeogenesis and glycogen storage. Diabetes mellitus (DM) commonly develops in patients with liver cirrhosis as the result of hepatocyte dysfunction and/or inadequate mass. To assess differences between DM due to liver cirrhosis (hepatogenous DM) and the other type 2 DM, we compared the patterns of hyperglycemia and hyperinsulinemia in hepatogenous DM with those observed in type 2 DM.

Methods: 18 diabetic patients with liver cirrhosis (caused by alcohol, n=8; HBV, n=5; HCV, n=2; others, n=3) were matched with 18 type 2 diabetic patients without liver cirrhosis for age and gender. None of the patients or controls had been treated with insulin or beta-blockers. The level of glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG), postprandial plasma glucose (PP2h), fasting plasma C-peptide and insulin were measured.

Results: The ratio of PP2h/FPG (2.27 vs. 1.69), fasting insulin (23.2: 11.6 microIU/mL) and HOMA-IR index (8.38 vs. 3.52) were significantly higher in hepatogenous DM than the other type 2 DM (P<0.05). PP2h, fasting C-peptide and ratio of fasting insulin/C-peptide tend to be higher in hepatogenous DM than those of controls, but which were not statistically significant.

Conclusions: The ratio of PP2h/FPG and fasting plasma insulin differentiated hepatogenous DM from the other type 2 DM. Insulin resistance in liver cirrhosis was higher than the other type 2 DM, and impaired hepatic insulin degradation might be an important mechanism of hyperinsulinemia in liver cirrhosis.