Diabetes co-existing with chronic liver disease: clinical features and response to therapy.

BACKGROUND AND OBJECTIVES: Diabetes mellitus (DM) and chronic liver disease (cirrhosis) may co-exist in the same individual. Diabetes may cause non-alcoholic steatohepatitis with necroinflammatory changes and granuloma formation leading to hepatic fibrosis. Cirrhosis of the liver from alcohol and hepatitis C infection, on the other hand, may give rise to insulin resistance or may result in progressive impairment of insulin secretion leading to DM. We studied the clinical features and response to therapy of diabetic patients with the two conditions to determine if there are differences in the clinical features and effects of the chronic liver disease (CLD) on the management of DM.

METHODS: This was a prospective study conducted at the Diabetes Clinic at the Jos University Teaching Hospital (JUTH) over a period of two years. Newly diagnosed diabetics with features of CLD (cirrhosis) were enrolled into the study after obtaining a consent. Age, sex, body mass index (BMI), family history of diabetes were recorded, as well as symptoms and signs of DM or CLD. Serum fasting blood glucose (FBS), prothrombin time ratio (PTR), and serum fasting lipids (serum lipoproteins and serum triglycerides) were measured. Urinalysis was done. The responses to therapy were classified as very rapid, rapid and gradual based on our previous unpublished observations that diabetic patients with CLD responded briskly to antidiabetes therapy.

RESULTS: 26 patients(19 men, and 7 women) were seen with both diseases agreed to participate in the study This accounted for 8.6% of the diabetic population attending the diabetes clinic. The mean age of the patients was 54.6 (9.2) years spanning a range of 34-75 years. Mean BMI was 21.6 (6.0) kg/m2. The mean serum albumin concentration was 25.5 (8.5) g/l, mean FBS was 15.5 ( 3.4) mmol/l and PTR was 1.6 (0.43). Urinalysis showed glycosuriain all patients with only one patient showing trace of ketonuria. Clinical features of DM and CLD were few each. There was a brisk response to insulin therapy so that one needs to be cautious with insulin administration.

CONCLUSION: Diabetes in patients with CLD has similar but fewer features compared to patients with type2 DM. CLD affects the response to therapy, particularly insulin therapy and calls for caution, as these patients may be sensitive to therapy.