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DOI: 10.1055/s-0029-1241573
Hepatogenous diabetes in liver cirrhosis – academic sport or a neglected disease? A study of current practice
Aims: Hepatogenous diabetes (HD) is frequently prevalent in liver cirrhosis (LC) and represents an important prognostic risk factor for decreased long-term survival and an increased rate of several complications. However, investigations of current practice concerning treatment are extremely sparse.
Aims and methods: To evaluate the awareness of this problem questionnaires were sent to 576 members of the Bavarian Society of Gastroenterology. Furthermore, a retrospective study of a large series of patients with LC and HD (n=55) was performed analysing several features of interest including anti-diabetic treatment, prognostic impact of a sufficient glycemic control and frequency of LC-related and diabetes-induced sequelae which were compared with a huge series of cirrhotics (n=354) without diabetes.
Results: Only 23 (9,1%) and 145 (57,3%), respectively, of the respondents could name the correct prevalence of impaired glucose tolerance and diabetes in advanced LC while 60 (23,7%) underestimated and 39 (15,4%) overestimated this problem. The vast majority of diabetic patients in our cirrhotic population showed no sufficient glycemic control (76,4%). 53,4% received insulin therapy alone and in 7,3% in combination with oral hypoglycemic agents. Remarkably, 32,7% received anti-diabetic therapy which should be avoided in HD due to contraindications while 18,2% reported about chronic alcohol abuse and 49% were described as incompliant. Compared to cirrhotics without diabetes, the frequency of typical complications associated with LC and diabetes-induced sequelae was significantly higher in patients with HD. However, we found no significant difference comparing diabetic cirrhotics demonstrating a sufficient glycemic control and without.
Conclusion: Even in an expert collective, HD represents an underestimated complication of liver LC. The current practice of anti-diabetic treatment seems to be inappropriate. Anti-diabetic treatment of diabetes in LC should be always an individual decision depending e.g. on the patient's compliance, comorbidities and the stage of cirrhosis. Regarding the limited variety of anti-diabetic medication in LC and the increased risk of hypoglycemia, further studies analysing patient-oriented end-points are necessary.