title: Hepatogenous diabetes in cirrhosis is related to portal pressure and variceal hemorrhage.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  HD and IR have significant relationships with PHT and variceal hemorrhage. Postprandial hyperglycemia in particular had a significant relationship with variceal hemorrhage.
authors.affiliation: Department of Internal Medicine, Wonju College of Medicine, Wonju Christian Hospital, Yonsei University, 162, Ilsan-dong, Wonju, Republic of Korea.
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Jeon
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Hoon
authors.initials: H
authors.lastname: Choi
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Park
authors.forename: Bo Ra
authors.initials: BR
authors.lastname: Kim
authors.forename: Jin Heon
authors.initials: JH
authors.lastname: Hong
authors.forename: Ki Won
authors.initials: KW
authors.lastname: Jo
authors.forename: Seung Yong
authors.initials: SY
authors.lastname: Shin
authors.forename: Jung Min
authors.initials: JM
authors.lastname: Kim
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Cha
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Suk
authors.forename: Gab Jin
authors.initials: GJ
authors.lastname: Cheon
authors.forename: Young Don
authors.initials: YD
authors.lastname: Kim
authors.forename: Dae Hee
authors.initials: DH
authors.lastname: Choi
authors.forename: Sung Joon
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D003920:Diabetes Mellitus / Q000209:etiology*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000473:pathology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000473:pathology*; D018149:Glucose Intolerance; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure
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