title: Transjugular intrahepatic portosystemic shunt (TIPS) augments hyperinsulinemia in patients with cirrhosis.
abstract: OBJECTIVE
  Cirrhosis of the liver is characterized by glucose intolerance and hyperinsulinemia. Both increased insulin secretion and decreased insulin clearance appear to contribute to hyperinsulinemia in cirrhotic patients. A decrease in hepatic insulin extraction rate may be due either to hepatocellular dysfunction or to portosystemic shunting with decreased first-pass insulin clearance.
  
  
  METHODS
  To specifically address the contribution of portosystemic shunting to the pathogenesis of hyperinsulinemia in cirrhotic patients, we analyzed glycemic control and insulin levels in fasting serum in 23 cirrhotic patients before and after transjugular intrahepatic portosystemic shunt (TIPS).
  
  
  RESULTS
  Compared to respective values in healthy controls, C-peptide, insulin and proinsulin concentrations at baseline were increased by 340%, 120% and by 100% in cirrhotic patients (all p<0.05). In cirrhotic patients insulin levels before TIPS averaged 104+/-73 pmol/l and increased by more than 50% to 163+/-118 pmol/l after TIPS (p<0.01), whereas levels of C-peptide and proinsulin showed no significant change. Glucose and fructosamin levels also remained unchanged after TIPS.
  
  
  CONCLUSIONS
  Our data demonstrate that TIPS does not impair glycemic control in cirrhotic patients and that an increase in portosystemic shunting augments hyperinsulinemia, most likely by decreasing hepatic insulin clearance.
authors.affiliation: Department of Medicine, University of Innsbruck, Austria.
authors.forename: S
authors.initials: S
authors.lastname: Kaser
authors.forename: B
authors.initials: B
authors.lastname: Föger
authors.forename: P
authors.initials: P
authors.lastname: Waldenberger
authors.forename: K
authors.initials: K
authors.lastname: Nachbaur
authors.forename: A
authors.initials: A
authors.lastname: Propst
authors.forename: W
authors.initials: W
authors.lastname: Jaschke
authors.forename: W
authors.initials: W
authors.lastname: Vogel
authors.forename: J R
authors.initials: JR
authors.lastname: Patsch
mesh_terms: D001201:Ascites / Q000517:prevention & control; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D005260:Female; D019270:Fructosamine / Q000097:blood; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood* / Q000150:complications*; D007328:Insulin / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011384:Proinsulin / Q000097:blood; D012016:Reference Values
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D019270:Fructosamine; D011384:Proinsulin