title: Clinical manifestations and treatment options in patients with cirrhosis and diabetes mellitus.
abstract: BACKGROUND
  Diabetes is frequently diagnosed in patients with cirrhosis and represents an important risk factor for morbidity and mortality. Pharmacological therapy is limited due to hepatotoxicity and the risk of hypoglycemia. Investigations on medical practice in this patient population, frequency of diabetes-associated complications and the impact of quality of metabolic control are rare.
  
  
  OBJECTIVE
  A retrospective analysis was performed to compare the effects of hypoglycemic treatment, the achieved glycemic control under therapy, the prevalence of typical cirrhosis-related or microangiopathic complications, and cardiovascular comorbidities between a group of diabetic patients with cirrhosis (n = 87) and a nondiabetic cirrhotic population (n = 198).
  
  
  RESULTS
  The prevalence of diabetes in our cohort was 30.5%. Of all diabetic patients, 39.1% received therapy which might potentially result in serious side effects in patients with end-stage liver disease. The rate of ongoing alcohol abuse (28.7%) and noncompliance under medication (41.4%) was high. Only 28.7% of all diabetic subjects showed satisfactory (as defined by HbA1c ≤ 6.5%) glycemic control under therapy. Patients achieving satisfactory control experienced a lower rate of certain cirrhosis-related complications such as hepatic encephalopathy (HE) and hepatocellular carcinoma (HCC), arterial hypertension, and hypercholesterolemia. HE was significantly more frequent in diabetic than nondiabetic cirrhotic patients.
authors.affiliation: Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Bogenhausen Academic Teaching Hospital, Technical University of Munich, Munich, Germany. Gastroenterologie@kh-bogenhausen.de
authors.forename: F
authors.initials: F
authors.lastname: Gundling
authors.forename: H
authors.initials: H
authors.lastname: Seidl
authors.forename: I
authors.initials: I
authors.lastname: Strassen
authors.forename: B
authors.initials: B
authors.lastname: Haller
authors.forename: T
authors.initials: T
authors.lastname: Siegmund
authors.forename: A
authors.initials: A
authors.lastname: Umgelter
authors.forename: C
authors.initials: C
authors.lastname: Pehl
authors.forename: W
authors.initials: W
authors.lastname: Schepp
authors.forename: P M
authors.initials: PM
authors.lastname: Schumm-Draeger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D015897:Comorbidity; D048909:Diabetes Complications / Q000188:drug therapy* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents