Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
HEPATOGENOUS DIABETES MELLITUS IN LIVER CIRRHOSIS: RELATIONSHIP WITH PORTAL PRESSURE AND VARICEAL HEMORRHAGE
M.Y. Kim1*, S.K. Baik1, C.S. Won1, J.W. Byun1, H.J. Park1, H.J. Choi1, Y.O. Jang1, S.Y. Park1, Y.H. Kwon1, D.J. Kim2, J.H. Kim2, G.J. Cheon3, Y.D. Kim3, S.J. Lee4, D.H. Choi4
1Department of Internal Medicine and Institute of Basic Medical Science, Yonsei University Wonju College of Medicine, Wonju, 2Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, 3Department of Internal Medicine, Kangneung Asan Hospital, Ulsan University College of Medicine, Kangneung, 4Department of Internal Medicine, Kangwon National University College of Medicine, Chuncheon, Republic of Korea. *email@example.com
Background and aim: Diabetes related with liver disease, so called hepatogenous diabetes mellitus(HDM) is frequent in cirrhotic patients. However, few studies were done about the clinical impact of HDM for cirrhosis and its complications. The present study aimed to evaluate the relationship of HDM with portal hypertension and variceal bleeding as well as its prevalence.
Methods: From July 2007 to December 2008, 75gm oral glucose tolerance test(OGTT), insulin resistance(IR) were evaluated for 195 cirrhotic patients(M: F=164: 31, 53.0±10.2 years) who had no history of diabetes mellitus. IR was calculated with the formula HOMA-IR=[fasting insulin (µIU/mL)×fasting glucose(mg/dL)]/405. In addition, upper endoscopy for varix, radiological image studies, hepatic venous pressure gradient(HVPG) and serologic tests were undertaken.
Results: The prevalence of HDM in cirrhosis was 54.9%(107/194). Among them, 62.9% needed to be taken OGTT for diagnosis because they did not show any abnormality in the fasting glucose test. The presence of HDM showed significant correlation with high Child-Pugh's score, variceal hemorrhage and high HVPG(P< 0.05). In multivariate analysis, Child-Pugh's score showed significant relationship with HDM(odds ratio=1.43, 95% Confidential Interval: 1.005-2.038). In addition, variceal bleeder within recent 6 months showed significantly higher glucose level at 2 hour in OGTT compared to non-bleeder(P< 0.05). However, fasting glucose level showed no difference between them. The mean HOMA-IR was 2.6±2.1 and 16.9%(33 patients) showed high IR(HOMA-IR≥4). High IR was implicated with high HVPG and variceal bleeding(P< 0.05). However, high IR showed no significant correlation with Child-Pugh's score, MELD score and etiology of cirrhosis(P>0.05).
Conclusion: More than 50% of cirrhotic patients showed HDM in OGTT. HDM and high IR have significant relationship with severe portal hypertension and variceal bleeding. Especially, postprandial hyperglycemia which is characteristics of HDM showed significant relationship with variceal bleeding.