Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.
Diego García-Compeán, Emanuela Orsi, Ramesh Kumar, Felix Gundling, Tsutomu Nishida, Jesús Zacarías Villarreal-Pérez, Ángel N Del Cueto-Aguilera, José A González-González, Giuseppe Pugliese
Author Information
Diego García-Compeán: Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico. digarciacompean@prodigy.net.mx.
Emanuela Orsi: Diabetes Service, Endocrinology and Metabolic Diseases Unit, Fdn IRCCS Ca Granda, Endocrine Unit, Padigl Granelli, Milan 20121, Italy.
Ramesh Kumar: Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India.
Felix Gundling: Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Diabetics, Metabolism and Infectious Diseases, Sozialstiftung Bamberg, Bamberg 96049, Germany.
Tsutomu Nishida: Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan.
Jesús Zacarías Villarreal-Pérez: Department of Endocrinology, University Hospital, Autonomous University of Nuevo León, Monterrey 64700, Mexico.
Ángel N Del Cueto-Aguilera: Department of Gastroenterology and Internal Medicine, Faculty of Medicine, University Hospital, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico.
José A González-González: Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. José E González and Medical School, Monterrey 64460, Nuevo León, Mexico.
Giuseppe Pugliese: Department of Clinical and Molecular Medicine, La Sapienza University, Roma 00161, Italy.
Diabetes mellitus (DM) is common in liver cirrhosis (LC). The pathophysiological association is bidirectional. DM is a risk factor of LC and LC is a diabetogenic condition. In the recent years, research on different aspects of the association DM and LC has been intensified. Nevertheless, it has been insufficient and still exist many gaps. The aims of this review are: (1) To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis; (2) To evaluate the impact of DM on outcomes of LC patients; and (3) To select the most adequate management benefiting the two conditions. Literature searches were conducted using PubMed, Ovid and Scopus engines for DM and LC, diagnosis, outcomes and management. The authors also provided insight from their own published experience. Based on the published studies, two types of DM associated with LC have emerged: Type 2 DM (T2DM) and hepatogenous diabetes (HD). High-quality evidences have determined that T2DM or HD significantly increase complications and death pre and post-liver transplantation. HD has been poorly studied and has not been recognized as a complication of LC. The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure. In conclusion, the clinical impact of DM in outcomes of LC patients has been the most studied item recently. Nevertheless many gaps still exist particularly in the management. These most important gaps were highlighted in order to propose future lines for research.
