Current Concepts in Diabetes Mellitus and Chronic Liver Disease: Clinical Outcomes, Hepatitis C Virus Association, and Therapy

Abstract

Hereditary type 2 diabetes mellitus is a risk factor for chronic liver disease, and ~30 % of patients with liver cirrhosis develop diabetes. Diabetes mellitus has been associated with cirrhotic and non-cirrhotic hepatitis C virus liver infection, can aggravate the course the liver infection, and can induce a lower sustained response to antiviral treatment. Evidences that HCV may induce metabolic and autoimmune disturbances leading to hypobetalipoproteinemia, steatosis, insulin resistance, impaired glucose tolerance, thyroid disease, and gonadal dysfunction have been found. Prospective studies have demonstrated that diabetes increases the risk of liver complications and death in patients with cirrhosis. However, treatment of diabetes in these patients is complex, as antidiabetic drugs can promote hypoglycemia and lactic acidosis. There have been few therapeutic studies evaluating antidiabetic treatments in patients with liver cirrhosis published to date; thus, the optimal treatment for diabetes and the impact of treatment on morbidity and mortality are not clearly known. As numbers of patients with chronic liver disease and diabetes mellitus are increasing, largely because of the global epidemics of obesity and nonalcoholic fatty liver disease, evaluation of treatment options is becoming more important. This review discusses new concepts on hepatogenous diabetes, the diabetes mellitus–hepatitis C virus association, and clinical implications of diabetes mellitus in patients with chronic liver disease. In addition, the effectiveness and safety of old and new antidiabetic drugs, including incretin-based therapies, will be described.

Diagnosis and treatment of chronic hepatitis C with concomitant extrahepatic manifestations deserves a closer look

“…Therefore, the relationship between hepatogenic diabetes, diabetes mellitus and HCV infection as well as the prognosis of CHC with diabetes mellitus has always been a hot issue in clinical research. [9] In addition, it is noteworthy that after the type 2 diabetes mellitus patients are infected with HCV, the disease can progress more rapidly, and is more likely to deteriorate into liver fibrosis, cirrhosis, and even hepatocellular carcinoma (HCC), with a poor prognosis. Therefore, blood glucose should be monitored in CHC patients, especially in patients receiving Interferon therapy.…”

Hyponatremia in patients with liver diseases: not just a cirrhosis-induced hemodynamic compromise

“…It is well known that a close association exists between liver diseases and diabetes mellitus [19]. Diabetes mellitus (even newly diagnosed) is a known risk factor for liver disease (diabetic hepatopathy) presenting either as insulin resistance-associated nonalcoholic fatty liver disease or as direct glucotoxic-associated liver injury [20].…”

The Prevalence and Risk Factors of Type II Diabetes Mellitus Among Patients with Hepatitis B Virus: A Descriptive Correlational Study

“…Inflammatory mediators, such as tumor necrosis factor and nitric oxide, cause insulin dysfunction in the liver, as well as insulin resistance (8). Increased levels of tumor necrosis factor suppress tyrosine phosphorylation in insulin receptors and cause insulin resistance (9).…”

“…The replication of HBV in pancreatic cells also aggravates insulin dysfunction (9). On the other hand, insulin resistance, steatosis, and cytopathic effects of HBV can accelerate hepatic fibrosis (8).…”