title: The treatment of diabetes mellitus of patients with chronic liver disease.
abstract: About 80% of patients with liver cirrhosis may have glucose metabolism disorders, 30% show overt diabetes mellitus (DM). Prospective studies have demonstrated that DM is associated with an increased risk of hepatic complications and death in patients with liver cirrhosis. DM might contribute to liver damage by promoting inflammation and fibrosis through an increase in mitochondrial oxidative stress mediated by adipokines. Based on the above mentioned the effective control of hyperglycemia may have a favorable impact on the evolution of these patients. However, only few therapeutic studies have evaluated the effectiveness and safety of antidiabetic drugs and the impact of the treatment of DM on morbidity and mortality in patients with liver cirrhosis. In addition, oral hypoglycemic agents and insulin may produce hypoglycemia and lactic acidosis, as most of these agents are metabolized by the liver. This review discusses the clinical implications of DM in patients with chronic liver disease. In addition the effectiveness and safety of old, but particularly the new antidiabetic drugs will be described based on pharmacokinetic studies and chronic administration to patients. Recent reports regarding the use of the SGLT2 inhibitors as well as the new incretin-based therapies such as injectable glucagon-like peptide-1 (GLP-1) receptor agonists and oral inhibitors of dipeptidylpeptidase-4 (DPP-4) will be discussed. The establishment of clear guidelines for the management of diabetes in patients with CLD is strongly required.
authors.affiliation: Gastroenterology Service, University Hospital Dr. José E. González and Medical School.
authors.forename: Diego
authors.initials: D
authors.lastname: García-Compeán
authors.affiliation: Gastroenterology Service, University Hospital Dr. José E. González and Medical School.
authors.forename: José A
authors.initials: JA
authors.lastname: González-González
authors.affiliation: Endocrinology Service and Department of Internal Medicine, University Hospital Dr. José E. González and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Lavalle-González
authors.affiliation: Gastroenterology Service, University Hospital Dr. José E. González and Medical School.
authors.forename: Emmanuel I
authors.initials: EI
authors.lastname: González-Moreno
authors.affiliation: Gastroenterology Service, University Hospital Dr. José E. González and Medical School.
authors.forename: Héctor J
authors.initials: HJ
authors.lastname: Maldonado-Garza
authors.affiliation: Endocrinology Service and Department of Internal Medicine, University Hospital Dr. José E. González and Medical School. Universidad Autónoma de Nuevo León, Monterrey, Mexico.
authors.forename: Jesús Zacarías
authors.initials: JZ
authors.lastname: Villarreal-Pérez
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D002908:Chronic Disease; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008099:Liver / Q000378:metabolism*; D008107:Liver Diseases / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007004:Hypoglycemic Agents