INCIDENCE OF HEPATIC DYSFUNCTION IN PATIENTS WITH DIABETES MELLITUS ADMITTED IN DARBHANGA MEDICAL COLLEGE AND HOSPITAL
Keywords:Diabetes mellitus, Non-alcoholic fatty liver disease, Cirrhosis, Ascites
Objective: The objective of the study was to find out the difference in the severity of the disease, pattern of liver injury, and clinical and biochemical profile in patients with liver dysfunction with and without diabetes mellitus (DM) and metabolic syndrome.
Methods: It was an observational study, the study conducted in the Department of General Medicine, Darbhanga Medical College and Hospital. Fifty consecutive patients with liver dysfunction along with diabetes and 50 consecutive patients with liver dysfunction without diabetes who satisfied the following inclusion criteria and did not have any of the exclusion criteria were selected for the study during the study period from January 2020 to December 2021.
Results: The mean age in patients with and without D.M. was 52.54 years and 52.58 years, respectively, with no significant difference between the two groups (p=0.283). The causes of liver dysfunction were as follows: Alcohol in 40 patients (24 without D.M. and 16 with D.M.), cryptogenic in 41 (14 without D.M. and 27 with D.M.), hepatitis C virus in eight (three without D.M. and five with D.M.), and hepatitis B virus in 12 (nine in without D.M. and two in with D.M.). The D.M. group had a considerably higher frequency of patients with cryptogenic cirrhosis (p=0.007). Diabetic individuals exhibited a significantly higher frequency of anemia, hypoalbuminemia, and hypercreatininemia than non-diabetic patients, according to laboratory testing. The majority of the patients of both groups showed mild ascites (88% without D.M. vs. 82% with D.M.). It shows diabetic patients had significantly higher MELD and higher Child-Pugh scores (p=0.001 and 0.004, respectively).
Conclusion: D.M. is found all over the world, and there is a growing body of evidence associating it with cirrhosis. As a result, both are likely to rise in value. Coexisting diabetes appears to be linked to more severe liver injury and consequences preceding cirrhosis, as well as greater mortality once cirrhosis has developed.
Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: Systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011;378:31-40. DOI: 10.1016/s0140-6736(11)60679-x
Reid AE. Non-alcoholic fatty liver disease. In: Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/diagnosis/management. 8th ed. St Louis, Missouri, USA: Saunders; 2006. p. 1772-99. doi: 10.1016/j. cld.2017.08.007
Levinthal GN, Tavill AS. Liver disease and diabetes mellitus. Clin Diabetes 1999;17:73. PMID: 11321935
Guven A, Yavuz O, Cam M, Ercan F, Bukan N, Comunoglu C, et al. Effects of melatonin on streptozotocin-induced diabetic liver injury in rats. Acta Histochem 2006;108:85-93. doi: 10.1016/j. acthis.2006.03.005
Larter CZ, Farrell GC. Insulin resistance, adiponectin, cytokines in NASH: Which is the best target to treat? J Hepatol 2006;44:253-61. DOI: 10.1016/j.jhep.2005.11.030
Leclercq IA, Da Silva Morais A, Schroyen B, Van Hul N, Geerts A. Insulin resistance in hepatocytes and sinusoidal liver cells: Mechanisms and consequences. J Hepatol 2007;47:142-56. doi: 10.1016/j.jhep.2007.04.002
Bugianesi E, McCullough AJ, Marchesini G. Insulin resistance: A metabolic pathway to chronic liver disease. Hepatology 2005;42:987-1000. doi: 10.1002/hep.20920
Manna P, Das J, Ghosh J, Sil PC. Contribution of Type 1 diabetes to rat liver dysfunction and cellular damage via activation of NOS, PARP, IkappaBalpha/NF-kappaB, MAPKs, and mitochondria-dependent pathways: Prophylactic role of arjunolic acid. Free Radic Biol Med 2010;48:1465-84. doi: 10.1016/j.freeradbiomed.2010.02.025
Palsamy P, Sivakumar S, Subramanian S. Resveratrol attenuates hyperglycemia-mediated oxidative stress and proinflammatory cytokines and protects hepatocytes’ ultrastructure in streptozotocin-nicotinamide-induced experimental diabetic rats. Chem Biol Interact 2010;186:200-10. doi: 10.1016/j.cbi.2010.03.028
Romagnoli M, Gomez-Cabrera MC, Perrelli MG, Biasi F, Pallardó FV, Sastre J, et al. Xanthine oxidase-induced oxidative stress causes activation of NF-kappaB and inflammation in the liver of Type I diabetic rats. Free Radic Biol Med 2010;49:171-7. doi: 10.1016/j. freeradbiomed.2010.03.024
Porepa L, Ray JG, Sanchez-Romeu P, Booth GL. Newly diagnosed diabetes mellitus is a risk factor for serious liver disease. CMA 2010;182:E526-31. doi: 10.1503/cmaj.092144
Cohen JC, Horton JD, Hobbs HH. Human fatty liver disease: Old questions and new insights. Science 2011;332:1519-23. doi: 10.1126/ science.1204265
Mehta SH, Brancati FL, Strathdee SA, Pankow JS, Netski D, Coresh J, et al. Hepatitis C virus infection and incident Type 2 diabetes. Hepatology 2003;38:50-6. doi: 10.1053/jhep.2003.50291
GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388:1459-544. https://doi.org/10.1016/S0140-6736(16)31012-1
Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: A systematic analysis. BMC Med 2014;12:145. https:// www.biomedcentral.com/1741-7015/12/159
Popa L, Ray JG, Sanchez-Romeu P, Booth L. Newly diagnosed diabetes mellitus as a risk factor for serious liver disease. CMAJ 2010;182:E526-31.
Falck-Letter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical features and natural history of non-alcoholic steatosis syndromes. Semin Liver Dis 2001;21:17-26. doi: 10.1055/s-2001-12926
Matteoni CA, Younossi ZM, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: A spectrum of clinical and pathological severity. Gastroenterol 1999;116:1413-9. doi: 10.1016/s0016-5085(99)70506-8
Ratziu V, Massard J, Charlotte F, Messous D, Imbert-Bismut F, Tahiri LB, et al. Diagnostic value of biochemical markers (FibroTest-FibroSURE) for prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol 2006;6:6. doi: 10.1186/1471-230X-6-6
Angulo P. GI epidemiology: Nonalcoholic fatty liver disease. Aliment Pharmacol Ther 2007;25:883-9. doi: 10.1111/j.1365-2036.2007.03246.x
Mehta SH, Brancati FL, Sulkowski MS, Strathdee SA, Szklo M, Thomas DL. Prevalence of Type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000;133:592-9. doi: 10.7326/0003-4819-133-8-200010170-00009
Holstein A, Hinze S, Thiessen E, Plaschke A, Egberts EH. Clinical implications of hepatogenous diabetes in liver cirrhosis. J Gastroenterol Hepatol 2002;17:677-81. doi: 10.1046/j.1440-1746.2002.02755.x
Nishida T, Tsuji S, Tsujii M, Arimitsu S, Haruna Y, Imano E, et al. Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis. Am J Gastroenterol 2006;101:70-5. doi: 10.1111/j.1572- 0241.2005.00307.x
Whitehead JP, Richards AA, Hickman IJ, Macdonald GA, Prins JB. Adiponectin-a key adipokine in the metabolic syndrome. Diabetes Obes Metab 2006;8:264-80. doi: 10.1111/j.1463-1326.2005.00510.x
Moreau R, Delegue P, Pessione F, Hillaire S, Durand F, Lebrec D, et al. Clinical characteristics and outcome of patients with cirrhosis refractory ascites. Liver Int 2004;24:457-64. doi: 10.1111/j.1478- 3231.2004.0991.x
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