Differential Diagnosis of Diabetes Mellitus caused by Liver Cirrhosis and Other Type 2 Diabetes Mellitus

Korean J Hepatol > Volume 12(4); 2006 > Article

The Korean Journal of Hepatology 2006;12(4): 524-529.

Differential Diagnosis of Diabetes Mellitus caused by Liver Cirrhosis and Other Type 2 Diabetes Mellitus

Min Geun Kim , Won Choong Choi

Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

ABSTRACT

Background
/Aim: The liver plays important roles in the homeostasis of glucose metabolism since it acts as a major target organ for insulin and a site for gluconeogenesis and glycogen storage. Diabetes mellitus (DM) commonly develops in patients with liver cirrhosis as the result of hepatocyte dysfunction and/or inadequate mass. To assess differences between DM due to liver cirrhosis (hepatogenous DM) and the other type 2 DM, we compared the patterns of hyperglycemia and hyperinsulinemia in hepatogenous DM with those observed in type 2 DM. Methods: 18 diabetic patients with liver cirrhosis (caused by alcohol, n=8; HBV, n=5; HCV, n=2; others, n=3) were matched with 18 type 2 diabetic patients without liver cirrhosis for age and gender. None of the patients or controls had been treated with insulin or β-blockers. The level of glycosylated hemoglobin (HbA1C), fasting plasma glucose (FPG), postprandial plasma glucose (PP2h), fasting plasma C-peptide and insulin were measured. Results: The ratio of PP2h/FPG (2.27 vs. 1.69), fasting insulin (23.2: 11.6 ?IU/mL) and HOMA-IR index (8.38 vs. 3.52) were significantly higher in hepatogenous DM than the other type 2 DM (P<0.05). PP2h, fasting C-peptide and ratio of fasting insulin/C-peptide tend to be higher in hepatogenous DM than those of controls, but which were not statistically significant. Conclusions: The ratio of PP2h/FPG and fasting plasma insulin differentiated hepatogenous DM from the other type 2 DM. Insulin resistance in liver cirrhosis was higher than the other type 2 DM, and impaired hepatic insulin degradation might be an important mechanism of hyperinsulinemia in liver cirrhosis. (Korean J Hepatol 2006;12:524-529)

KeyWords: Liver cirrhosis; Diabetes mellitus, type 2; Insulin resistance; Diagnosis