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Hepatogenous Diabetes in Cirrhosis Is Related to Portal Pressure and Variceal Hemorrhage

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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.

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Abbreviations

HD:

Hepatogenous diabetes

HVPG:

Hepatic venous pressure gradient

MELD:

Model for end-stage liver disease

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Acknowledgment

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (HI10C2020 and A100054).

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Correspondence to Soon Koo Baik.

Additional information

Hyo Keun Jeon and Moon Young Kim have contributed equally to this research.

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Jeon, H.K., Kim, M.Y., Baik, S.K. et al. Hepatogenous Diabetes in Cirrhosis Is Related to Portal Pressure and Variceal Hemorrhage. Dig Dis Sci 58, 3335–3341 (2013). https://doi.org/10.1007/s10620-013-2802-y

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  • DOI: https://doi.org/10.1007/s10620-013-2802-y

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