Hepatogenous diabetes in cirrhosis is related to portal pressure and variceal hemorrhage

Hyo Keun Jeon, Moon Young Kim, Soon Koo Baik, Hong Jun Park, Hoon Choi, So Yeon Park, Bo Ra Kim, Jin Heon Hong, Ki Won Jo, Seung Yong Shin, Jung Min Kim, Jae Woo Kim, Hyun Soo Kim, Sang Ok Kwon, Young Ju Kim, Seung Hwan Cha, Dong Joon Kim, Ki Tae Suk, Gab Jin Cheon, Young Don KimDae Hee Choi, Sung Joon Lee

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Abstract

Background and Aim: The clinical impact and complications of hepatogenous diabetes (HD) on cirrhosis have not been elucidated. This study aimed to evaluate the relationship of HD with portal hypertension (PHT) and variceal hemorrhage and to assess the prevalence of HD. Methods: From July 2007 to December 2009, 75-g oral glucose tolerance test and insulin resistance (IR) were evaluated for 195 consecutive cirrhotic liver patients (M:F = 164:1, 53.0 ± 10.2 years) who had no history of diabetes mellitus. IR was calculated using the homeostasis model of assessment-insulin resistance (HOMA-IR) formula. Endoscopy for varices, hepatic venous pressure gradient (HVPG), and serologic tests were also conducted. Results: HD was observed in 55.4 % (108/194) of the patients. Among them, 62.0 % required OGTT for diagnosis because they did not show an abnormal fasting plasma glucose level. The presence of HD showed a significant correlation with high Child-Pugh's score, variceal hemorrhage, and HVPG (p = 0.004, 0.002, and 0.019, respectively). In multivariate analysis, Child-Pugh's score (OR 1.43, 95 % CI 1.005-2.038) and HVPG (OR 1.15, 95 % CI 1.003-2.547) had significant relationships with HD. Patients with recent variceal hemorrhages (within 6 months) exhibited significantly higher glucose levels at 120 min in OGTT compared to patients without hemorrhages (p = 0.042). However, there was no difference in fasting glucose levels. The 120-min glucose level and HOMA-IR score were significantly and linearly correlated with HVPG (r 2 = 0.189, p < 0.001 and r 2 = 0.033, p = 0.011, respectively). Conclusion: HD and IR have significant relationships with PHT and variceal hemorrhage. Postprandial hyperglycemia in particular had a significant relationship with variceal hemorrhage.

Original languageEnglish
Pages (from-to)3335-3341
Number of pages7
JournalDigestive diseases and sciences
Volume58
Issue number11
DOIs
Publication statusPublished - 2013 Nov

All Science Journal Classification (ASJC) codes

  • Physiology
  • Gastroenterology

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    Jeon, H. K., Kim, M. Y., Baik, S. K., Park, H. J., Choi, H., Park, S. Y., Kim, B. R., Hong, J. H., Jo, K. W., Shin, S. Y., Kim, J. M., Kim, J. W., Kim, H. S., Kwon, S. O., Kim, Y. J., Cha, S. H., Kim, D. J., Suk, K. T., Cheon, G. J., ... Lee, S. J. (2013). Hepatogenous diabetes in cirrhosis is related to portal pressure and variceal hemorrhage. Digestive diseases and sciences, 58(11), 3335-3341. https://doi.org/10.1007/s10620-013-2802-y