DIABETES AS A CAUSE OF DECOMPENSATION IN HEPATIC CIRRHOSIS

Introduction and objectives

Cirrhosis and diabetes mellitus are two chronic diseases with a significant impact on quality of life glucose intolerance has been observed in about 80% of patients with cirrhosis, 30-60% of patients with advanced cirrhosis develop diabetes. The development of diabetes as a complication of cirrhosis is referred to as hepatogenic diabetes and type 2 diabetes which the patient develops prior to the presence of cirrhosis. Hepatogenic diabetes, unlike diabetes mellitus, lacks a family history, less obesity, and a lower incidence of micro and macrovascular complications. Diabetes increases morbidity and mortality in patients with liver cirrhosis. The effect of type 2 diabetes and hepathogenic diabetes on the clinical outcome of cirrhosis has been evaluated in a few studies. Diabetes mellitus has been shown to be associated with an increased risk of complications and mortality. We consider it important to assess the association between the type of diabetes (hepatogenic and non-hepatogenic) with the presence of decompensation of cirrhosis (hemorrhage, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis).

Material and methods

Ambispective, observational, descriptive study. Patients with a diagnosis of liver cirrhosis and diabetes from an outpatient clinic at the General Hospital of Ticomán and a review of the clinical record are included, collecting information on decompensation events (hemorrhage, hepatic encephalopathy, spontaneous bacterial peritonitis, ascites). Descriptive analysis is performed of the variables.

Results

Twenty-eight patients were included, of whom 15 suffer from type 2 diabetes mellitus and 13 of them were diagnosed with hepatogenic diabetes. Hepatogenic diabetes was diagnosed in 9 patients with impaired fasting glucose levels and in 4 patients with a glucose tolerance curve. In both groups, the male gender predominated (53.3 and 61% respectively), the main etiology of alcohol cirrhosis. In the group with hepatogenic diabetes, 76.92% presented some decompensation event, the most frequent being upper gastrointestinal bleeding in 80%. In this group of patients, they correspond to Child A 53.84%, Child B 38.46 and Child C 7.69%. 76.92% of the patients had a portal diameter greater than 10mm, 61.53% of the patients had large esophageal varices. In 53.84% of the patients, they were difficult to control, receiving treatment with a combination of insulin and metformin. On the other hand, in the group of patients with diabetes mellitus 69.23% presented decompensation, the most common hemorrhage in 46.66%, of these patients 33.3% Child A, 53.33% Child B and 13.33% Child C. 53.33% had a diameter of the portal greater than 10mm and 61.53 large esophageal varices. 33.33% of the patients were difficult to manage, being treated with combinations of insulin, metformin and linagliptin.

Discussion

The association of diabetes with decompensation events has been observed in some studies, Del Vecchio et al. found that diabetes was more frequent in subjects with decompensation than in those with compensated cirrhosis, with a prevalence of 63%. Targest et al. Diabetes is commonly associated with a significant increase in the development of spontaneous bacterial peritonitis. Goh et al. Diabetes is associated with an increased risk of mortality in patients with cirrhosis.

Conclusions

In our study, we observed that decompensation events were more common in the group of patients with hepatogenic cirrhosis, being the main gastrointestinal bleeding, in addition to presenting a larger diameter of the portal vein on ultrasound and a higher percentage of large esophageal varices. And we observed this group of patients presented difficult management of glucose levels being treated with combinations of insulin and metformin.

The authors declare that there is no conflict of interest.