Aims: The aim of this study was to investigate the frequency of diabetes mellitus
(DM) among cirrhotic inpatients with different etiologies and the impact of DM on
the prognosis of these patients. Methods: A retrospective study of the
association between DM and cirrhosis was performed on 672 cirrhotic inpatients
at the First Affiliated Hospital of Anhui Medical University from January 1, 2012
to March 1, 2013. Data were assessed using SPSS 20.0. Results: The DM prevalences
involving different etiologies were 45.08%, 40.43%, 42.85%, 41.67%, and 25.56%
among 672 patients with alcoholic cirrhosis, cryptogenic cirrhosis,
schistosomiasis, chronic hepatitis C, and chronic hepatitis B, respectively.
Multivariate analysis indicated that relative to non-diabetic patients, patients
with DM were older (OR 2.83, 95% CI 2.78 - 2.87, p < 0.001), had higher white blood cell levels (OR 3.01, 95% CI 2.83
- 3.22, p = 0.001) and were more frequently
Child-Pugh class C (OR 1.28, 95% CI 1.14 - 1.55, p < 0.001); these differences were also statistically significant
in univariate analysis. Univariate analysis suggested that the presence of DM
was associated with a higher international normalized ratio (p = 0.013), a higher incidence of
hepatic encephalopathy (p = 0.014), and
a more frequent incidence of spontaneous bacterial peritonitis (p < 0.001). Conclusion: DM is
extremely common among cirrhotic patients and is particularly prevalent among alcoholic
cirrhosis patients in the examined region of China. The presence of DM in
cirrhotic patients was strongly associated with an elevated Child-Pugh score
and an accelerated progression of cirrhosis.
Cite this paper
Hu, L. , Xu, X. , Zhou, Z. , Chen, G. , Ying, H. , Ye, Y. and Li, J. (2015). Role of Diabetes Mellitus in Liver Cirrhosis in the Anhui Region of China. Open Access Library Journal, 2, e2101. doi: http://dx.doi.org/10.4236/oalib.1102101.
Barthel, A. and Schmoll, D. (2003) Novel Concepts in Insulin Regulation of Hepatic Gluconeogenesis. American Journal of Physiology -
Endocrinology and Metabolism, 285, 685-692. http://dx.doi.org/10.1152/ajpendo.00253.2003
Picardi, A., D’Avola, D., Gentilucci, U.V., et al. (2006) Diabetes in Chronic Liver Disease: From Old
Concepts to New Evidence. Diabetes/Metabolism Research and Reviews, 22, 274-283. http://dx.doi.org/10.1002/dmrr.636
Hickman, I.J. and Macdonald, G.A. (2007) Impact of Diabetes on the Severity of Liver Disease. The American Journal of Medicine, 120, 829-834. http://dx.doi.org/10.1016/j.amjmed.2007.03.025
Quintana, J.O., Garcia-Compean, D., Gonzdlez, J.A., Pérez, J.Z., González, F.J., et al. (201l) The Impact of Diabetes Mellitus in Mortality of Patients with Compensated
Liver Cirrhosis a Prospective Study. Annals
of Hepatology, 10, 56-62.
Zein, N.N., Abdulkarim, A.S., Wiesner, R.H., Egan, K.S. and Persing, D.H. (2000) Prevalence of Diabetes Mellitus in Patients with
End-Stage Liver Cirrhosis Due to Hepatitis C, Alcohol, or Cholestatic Disease. Journal of Hepatology, 32, 209-217. http://dx.doi.org/10.1016/S0168-8278(00)80065-3
Holstein, A., Hinze, S., Thiessen, E., Plaschke, A. and Egberts, E.H. (2002) Clinical Implications of Hepatogenous Diabetes in Liver Cirrhosis. Journal of Gastroenterology and
Hepatology, 17, 677-681. http://dx.doi.org/10.1046/j.1440-1746.2002.02755.x
Wlazlo, N., Beijers, H.J., Schoon, E.J., Sauerwein, H.P. and Stehouwer, C.D. and Bravenboer, B. (2010) High Prevalence of Diabetes
Mellitus in Patients with Liver Cirrhosis. Diabetic Medicine, 27, 1308-1311. http://dx.doi.org/10.1111/j.1464-5491.2010.03093.x
Huang, J.F., Yu, M.L., Dai, C.Y. and Chuang, W.L. (2013)Glucose Abnormalities in Hepatitis C Virus
Infection. Kaohsiung Journal of
Medical Sciences, 29, 61-68. http://dx.doi.org/10.1016/j.kjms.2012.11.001
Sporea, I., Sirli, R., Hogea, C., Sink, A.A. and Serban, V. (2009) Diabetes Mellitus and Chronic
HCV Infection. Romanian
Journal of Internal Medicine, 47, 141-147.
Lonardo, A., Adinolfi, L.E., Petta, S., Craxì, A. and Loria, P. (2009) Hepatitis C and Diabetes: The Inevitable Coincidence? Expert Review of Anti-Infective Therapy, 7, 293-308. http://dx.doi.org/10.1586/eri.09.3
Elgouhari, H.M., Zein, C.O., Hanouneh, I., Feldstein, A.E. and Zein, N.N.
(2009) Diabetes Mellitus Is Associated with Impaired Response to Antiviral Therapy in Chronic
Hepatitis C Infection. Digestive
Diseases and Sciences, 54, 2699- 2705. http://dx.doi.org/10.1007/s10620-008-0683-2
Ferenci, P., Lockwood, A., Mullen, K., Tarter, R., Weissenborn, K. and Blei, A.T.
(2002) Hepatic Encephalopathy: Definition, Nomenclature,
Diagnosis, and Quantification: Final Report of the Working Party at the 11th
World Congresses of Gastroenterology, Vienna, 1998. Hepatology, 35, 716-721. http://dx.doi.org/10.1053/jhep.2002.31250
Garcia-Compean, D.,
Jaquez-Quintana, J.O., Gonzalez-Gonzalez, J.A. and Maldonado-Garza, H.
(2009) Liver Cirrhosis and Diabetes: Risk
Factors, Pathophysiology, Clinical Implications and Management. World Journal of Gastroenterology, 15, 280-288. http://dx.doi.org/10.3748/wjg.15.280
European
Association for the Study of the L (2010) EASL Clinical Practice Guidelines on the
Management of Ascites, Spontaneous Bacterial Peritonitis, and Hepatorenal
Syndrome in Cirrhosis. Journal of
Hepatology, 53, 397-417. http://dx.doi.org/10.1016/j.jhep.2010.05.004
Nielsen, M.F., Caumo, A., Aagaard, N.K., Chandramouli, V., Schumann, W.C., Landau, B.R., et al. (2005) Contribution of Defects in Glucose Uptake to
Carbohydrate Intolerance in Liver Cirrhosis: Assessment during Physiological
Glucose and Insulin Concentrations. American Journal of Physiology—Gastrointestinal and Liver Physiology, 288, 1135-1143. http://dx.doi.org/10.1152/ajpgi.00278.2004
Perry, R.J., Camporez, J.P.G., Kursawe, R., et al. (2015) Hepatic Acetyl CoA Links Adipose Tissue Inflammation to Hepatic
Insulin Resistance and Type 2 Diabetes. Cell, 160, 1-14. http://dx.doi.org/10.1016/j.cell.2015.01.012
Papatheodoridis, G.V.,
Chrysanthos, N., Savvas, S., et al. (2006) Diabetes Mellitus in Chronic Hepatitis B and
C: Prevalence and Potential Association with the Extent of Liver Fibrosis. Journal of Viral Hepatitis, 13, 303-310. http://dx.doi.org/10.1111/j.1365-2893.2005.00677.x
Ampuero, J., Ranchal, I., Del Mar
Díaz-Herrero, M., Del Campo, J.A., Bautista, J.D. and Romero-Gómez, M.
(2013) Role of Diabetes
Mellitus on Hepatic Encephalopathy. Metabolic
Brain Disease, 28, 277-279. http://dx.doi.org/10.1007/s11011-012-9354-2
Butt, Z., Jadoon, N.A., Salaria, O.N., Mushtaq, K., Riaz, I.B., Shahzad, A., et al. (2013) Diabetes Mellitus and Decompensated Cirrhosis: Risk of Hepatic
Encephalopathy in Different Age Groups. Journal
of Diabetes, 5, 449-455. http://dx.doi.org/10.1111/1753-0407.12067
Poh, Z. and Chang, P.E.
(2012) A Current Review of the Diagnostic and
Treatment Strategies of Hepatic Encephalopathy. International Journal of Hepatology, 2012, Article ID: 480309. http://dx.doi.org/10.1155/2012/480309
Wlazlo, N., van
Greevenbroek, M.M., Curvers, J., Schoon, E.J., Friederich, P., Twisk, J.W., et al. (2013) Diabetes Mellitus at the Time of Diagnosis
of Cirrhosis Is Associated with Higher Incidence of Spontaneous Bacterial
Peritonitis, but Not with Increased Mortality. Clinical Science, 125, 341-348. http://dx.doi.org/10.1042/CS20120596
Sigal, S.H., Stanca, C.M.,
Kontorinis, N., Bodian, C. and Ryan, E.
(2006) Diabetes Mellitus Is Associated with
Hepatic Encephalopathy in Patients with HCV Cirrhosis. American Journal of Gastroenterology, 101, 1490-1496. http://dx.doi.org/10.1111/j.1572-0241.2006.00649.x