Differences in characteristics of glucose intolerance between patients with NAFLD and chronic hepatitis C as determined by CGMS

Abstract

Glucose intolerance frequently develops in accordance with the progression of chronic liver disease. However, differences in the characteristics of glucose intolerance between patients with nonalcoholic fatty liver disease (NAFLD) and those with chronic hepatitis C (C-CH) remain incompletely understood. To clarify these differences, patients with NAFLD (n = 37) and C-CH (n = 40) were evaluated with a continuous glucose monitoring system (CGMS). In the patients with NAFLD, Maximum blood glucose concentration and blood glucose swings were significantly correlated with hepatic fibrosis markers. In the patients with C-CH, however, those two CGMS parameters were negatively correlated with the serum albumin (ALB) concentration. Furthermore, in the patients with C-CH with an ALB concentration of ≤4.0 g/dl, those two CGMS parameters were negatively correlated with the ALB concentration with greater statistical significance. In conclusion, obvious differences in the characteristics of glucose intolerance between patients with NAFLD and those with C-CH were clarified. In patients with NAFLD, glucose intolerance gradually progressed in accordance with the progression of hepatic fibrosis. In those with C-CH, glucose intolerance suddenly developed upon the appearance of hypoalbuminaemia.

Figure 1

Relationship between maximum blood glucose and various parameters in patients with NAFLD or C-CH. The maximum blood glucose was correlated with the fibrosis markers PLT count (r = −0.3388, P < 0.05), P-3-P (r = 0.4051, P < 0.05) and FIB-4 index (r = 0.3253, P < 0.05) in patients with NAFLD (n = 37) and with TP (r = −0.4749, P < 0.005), ALB (r = −0.5147, P < 0.001), HbA1c (r = 0.6027, P < 0.001), and 1,5-AG (r = −0.7020, P < 0.005) but not with fibrosis markers in patients with C-CH (n = 40).

Figure 2

Relationship between minimum blood glucose and various parameters in patients with NAFLD or C-CH. The minimum blood glucose was correlated with the PLT count (r = −0.3209, P < 0.05) and HbA1c (r = −0.5739, P < 0.001) in patients with C-CH (n = 40), but was not correlated with any parameters of liver function tests in patients with NAFLD (n = 37).

Figure 3

Relationship between BGS and various parameters in patients with NAFLD and C-CH. BGS were correlated with ALB (r = −0.3709, P < 0.05) and fibrosis markers such as the PLT count (r = −0.4114, P < 0.05), type IV collagen 7S (r = 0.3556, P < 0.05), P-3-P (r = 0.4796, P < 0.05), and the FIB-4 index (r = 0.3510, P < 0.05) in patients with NAFLD (n = 37) and with TP (r = −0.4574, P < 0.005), ALB (r = −0.4341, P < 0.01), HbA1c (r = 0.3963, P < 0.05), and 1,5-AG (r = −0.6193, P < 0.01) but not fibrosis markers in patients with C-CH (n = 40).

Figure 4

Relationship between blood glucose and ALB in patients with C-CH with ALB of ≤4.0 or >4.0 g/dl. In patients with C-CH with ALB of ≤4.0 g/dl (n = 31), the maximum blood glucose (r = −0.5722, P < 0.001) and BGS (r = −0.5006, P < 0.005) were correlated with the ALB concentration, but these correlations were not found in patients with ALB of >4.0 g/dl (n = 9).