High prevalence of diabetes mellitus in patients with liver cirrhosis.
OBJECTIVE
The reported prevalence of Type 2 diabetes mellitus in patients with liver cirrhosis is five times higher than in the general population. However, these data were never adjusted for classical risk factors for Type 2 diabetes. We therefore investigated the association between cirrhosis and Type 2 diabetes and adjusted for known risk factors for Type 2 diabetes.


METHODS
We reviewed medical files for presence of Type 2 diabetes and potential confounders in 94 patients with cirrhosis (cases) and compared these with a control group of 107 patients with non-ulcer dyspepsia. Multiple logistic regression analysis was used to adjust for potential confounders.


RESULTS
The aetiology of our cirrhosis population was alcohol (59%), viral hepatitis (10%), biliary cirrhosis (3%) or cryptogenic (28%). Prevalence of Type 2 diabetes was significantly higher in patients with cirrhosis than in control subjects: 35/94 (37%) vs. 7/107 (7%) (OR 8.5, 95% CI 3.5–20.2, P < 0.001). After adjustment for age, sex, family history of Type 2 diabetes, alcohol use and BMI, cirrhosis remained significantly associated with Type 2 diabetes (OR 13.6, 95% CI 4.3–42.9, P < 0.001). Most cases of Type 2 diabetes were already diagnosed before diagnosis of cirrhosis (21/35, 60%) or were incidentally found together with cirrhosis (5/35, 14%).


CONCLUSIONS
Liver cirrhosis had a strong, independent association with Type 2 diabetes. Classical risk factors such as family history and BMI could not explain the high Type 2 diabetes prevalence in cirrhosis. Therefore, a liver-derived factor might aggravate glucose intolerance and cause Type 2 diabetes in cirrhosis. In addition, Type 2 diabetes might also cause cirrhosis through liver steatosis and fibrosis.
Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands. nickwlazlo@gmail.com
N
N
Wlazlo
H J B H
HJ
Beijers
E J
EJ
Schoon
H P
HP
Sauerwein
C D A
CD
Stehouwer
B
B
Bravenboer
D048909:Diabetes Complications / Q000196:embryology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors