Glucose Metabolism Disorders in Cirrhosis: Frequency and Risk Factors in Tunisian Population. Results of a Cross-Sectional Study

Background and aims: Alterations in carbohydrate metabolism are frequently observed in cirrhosis; to determine the frequency of diabetes mellitus and impaired glucose tolerance in Tunisian cirrhotic patients and identify risk factors. Patients and methods: Cross-sectional study; fasting plasma glucose levels were measured in consecutive patients with cirrhosis. Oral glucose tolerance test was performed if fasting plasma glucose level was normal. Glucose metabolism disorders were then classified as: impaired glucose tolerance and diabetes mellitus. Cirrhotics with glucose metabolism disorder were compared to those without. Results: Seventy-seven patients with cirrhosis were included: 68.8% were diagnosed as having glucose metabolism disorder; diabetes in 42.8% and impaired glucose tolerance in 26%. The tests were able to identify 60.4% of glucose metabolism disorders. Univariate analysis disclosed a higher proportion of female gender (p = 0.04) and more frequent familial history of diabetes mellitus (p = 0.005) in the group with glucose metabolism disorder. There were no statistically differences regarding age, etiology and severity of the cirrhosis, and dry body mass index. Multivariate analysis showed that familial history of diabetes was the only independent risk factor (OR = 5.1, p = 0.005). Conclusion: In our study, the frequency of glucose metabolism disorders was 68.8%. Oral glucose tolerance test allowed disclosing nearly half of them, pointing a high incidence of latent glucose metabolism disorders. In this way, it should be routinely evaluated in all patients with cirrhosis. Familial history of diabetes was the only independent risk factor, suggesting that other factors in addition to liver disease may play a role.