Cirrhosis of Liver and Diabetes Mellitus: The Diabolic Duo?

Ramachandran, Thazhath Mavali; Rajneesh, Aninchent Harayil Rajan; Zacharia, George Sarin; Adarsh, Rajendran P

doi:10.7860/jcdr/2017/30705.10529

Cited by 16 publications

(13 citation statements)

References 39 publications

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“…Despite all the beneficial interventions implemented in patients with diabetes, including tight glucose control and tight blood pressure control with regimens that inhibit the renin angiotensin aldosterone system, renal disease still progresses in most diabetic patients. Diabetes is associated with a series of liver diseases including nonalcoholic fatty liver disease (NAFLD), nonalcoholic steatohepatitis (NASH), cirrhosis, fulminant hepatic failure and hepatocellular carcinoma [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

The Sodium-Glucose Cotransporter 2 Inhibitor Dapagliflozin Prevents Renal and Liver Disease in Western Diet Induced Obesity Mice

Wang

Luo

Wang

et al. 2018

IJMS

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Obesity and obesity related kidney and liver disease have become more prevalent over the past few decades, especially in the western world. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a new class of antidiabetic agents with promising effects on cardiovascular and renal function. Given SGLT2 inhibitors exert both anti-diabetic and anti-obesity effects by promoting urinary excretion of glucose and subsequent caloric loss, we investigated the effect of the highly selective renal SGLT2 inhibitor dapagliflozin in mice with Western diet (WD) induced obesity. Low fat (LF) diet or WD-fed male C57BL/6J mice were treated with dapagliflozin for 26 weeks. Dapagliflozin attenuated the WD-mediated increases in body weight, plasma glucose and plasma triglycerides. Treatment with dapagliflozin prevented podocyte injury, glomerular pathology and renal fibrosis determined by second harmonic generation (SHG), nephrin, synaptopodin, collagen IV, and fibronectin immunofluorescence microscopy. Oil Red O staining showed dapagliflozin also decreased renal lipid accumulation associated with decreased SREBP-1c mRNA abundance. Moreover, renal inflammation and oxidative stress were lower in the dapagliflozin-treated WD-fed mice than in the untreated WD-fed mice. In addition, dapagliflozin decreased serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), hepatic lipid accumulation as determined by H&E and Oil Red O staining, and Coherent Anti-Stokes Raman Scattering (CARS) microscopy, and hepatic fibrosis as determined by picrosirius red (PSR) staining and TPE-SHG microscopy in WD-fed mice. Thus, our study demonstrated that the co-administration of the SGLT2 inhibitor dapagliflozin attenuates renal and liver disease during WD feeding of mice.

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Section: Introductionmentioning

confidence: 99%

The Sodium-Glucose Cotransporter 2 Inhibitor Dapagliflozin Prevents Renal and Liver Disease in Western Diet Induced Obesity Mice

Wang

Luo

Wang

et al. 2018

IJMS

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“…Some other studies showed a greater risk for developing urinary infections [ 32 ], SBP and others, while DM was independently associated with bacterial infections in cirrhotic patients with HCV [ 20 ].…”

Section: Resultsmentioning

confidence: 99%

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Coman

Bădărău

et al. 2021

JCM

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Background: Liver cirrhosis (LC) is largely associated with diabetes mellitus (DM). More than 80% of patients with LC manifest glucose intolerance and about 30% have type 2 DM. A particular and yet unrecognized entity is hepatogenous diabetes (HD), defined as impaired glucose regulation caused by altered liver function following LC. Numerous studies have shown that DM could negatively influence liver-related outcomes. Aim: We aimed to investigate whether patients with LC and DM are at higher risk for hepatic encephalopathy (HE), variceal hemorrhage (VH), infections and hepatocellular carcinoma (HCC). The impact of DM on liver transplant (LT) outcomes was also addressed. Methods: Literature search was performed in PubMed, Ovid, and Elsevier databases. Population-based observational studies reporting liver outcomes in patients with LC were included. Results: Diabetics are at higher risk for HE, including post-transjugular intrahepatic portosystemic shunt HE. DM also increases the risk of VH and contributes to elevated portal pressure and variceal re-bleeding, while uncontrolled DM is associated with increased risk of bacterial infections. DM also increases the risk of HCC and contributes to adverse LT outcomes. Conclusions: Patients with DM and LC may benefit from close follow-up in order to reduce readmissions and mortality. Due to the heterogeneity of available research, prospective multicenter clinical trials are needed to further validate these findings.

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“…The results and conclusions presented here are based on systematically collected data from 3 multicentre trials. Out of 5 studies previously published within this area, 4 reported a relative risk of infections of >2.5 in patients with cirrhosis and diabetes compared to those with cirrhosis without diabetes [17][18][19][20][21] (Table S1). One possible way to explain the discrepancy with our findings is that cirrhosisin its most severe, decompensated stateconfers such an overwhelming risk of infections that any additional risk by diabetes becomes difficult to detect.…”

Section: Discussionmentioning

confidence: 99%

“…One possible way to explain the discrepancy with our findings is that cirrhosisin its most severe, decompensated stateconfers such an overwhelming risk of infections that any additional risk by diabetes becomes difficult to detect. Most of those previous studies did not describe the severity of cirrhosis, [17][18][19][20] but one of them was limited to patients with compensated cirrhosis 21 (Table S1). It found an HR for infections of 4.08 (95% CI 1.43-11.66) among patients with cirrhosis due to hepatitis B infection, but did not attempt to control for confounding.…”

Section: Discussionmentioning

confidence: 99%

“…This raises the question of whether the infection risk is additive in patients with more than 1 risk disease, and specifically whether this is the case in patients with cirrhosis and diabetes. Only a few studies have dealt with the issue, [17][18][19][20][21] and it remains unclear whether there is a difference in the risk of infections between patients with cirrhosis, with or without diabetes, particularly among patients with decompensated cirrhosis. It is also unclear whether diabetes affects mortality following an infection in patients with cirrhosis.…”

Section: Diabetes Does Not Increase Infection Risk or Mortality Follomentioning

confidence: 99%

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Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites

et al. 2019

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Cirrhosis of Liver and Diabetes Mellitus: The Diabolic Duo?

Abstract: Coexistent diabetes mellitus increases the incidence of complications and hospitalizations in cirrhosis patients but without impact on mortality rates. There is no significant morbidity or mortality difference between cirrhotics with antecedent diabetes and hepatogenous diabetes.

Cited by 16 publications

References 39 publications

The Sodium-Glucose Cotransporter 2 Inhibitor Dapagliflozin Prevents Renal and Liver Disease in Western Diet Induced Obesity Mice

The Sodium-Glucose Cotransporter 2 Inhibitor Dapagliflozin Prevents Renal and Liver Disease in Western Diet Induced Obesity Mice

Association between Liver Cirrhosis and Diabetes Mellitus: A Review on Hepatic Outcomes

Diabetes does not increase infection risk or mortality following an infection in patients with cirrhosis and ascites

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