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Cirrhosis And A1c

Diabetes: How Do I Help Protect My Liver?

Diabetes: How Do I Help Protect My Liver?

If I have diabetes, is there anything special I need to do to take care of my liver? Answers from M. Regina Castro, M.D. You're wise to wonder about steps to protect your liver. Diabetes raises your risk of nonalcoholic fatty liver disease, a condition in which excess fat builds up in your liver even if you drink little or no alcohol. This condition occurs in at least half of those with type 2 diabetes. It isn't clear whether the condition appears more often in people with type 1 diabetes than in the general population because obesity, which is a risk factor, occurs with similar frequency in both groups. Other medical conditions, such as high cholesterol and high blood pressure, also raise your risk of nonalcoholic fatty liver disease. Fatty liver disease itself usually causes no symptoms. But it raises your risk of developing liver inflammation or scarring (cirrhosis). It's also linked to an increased risk of liver cancer, heart disease and kidney disease. Fatty liver disease may even play a role in the development of type 2 diabetes. Once you have both conditions, poorly managed type 2 diabetes can make fatty liver disease worse. Your best defense against fatty liver disease includes these strategies: Work with your health care team to achieve good control of your blood sugar. Lose weight if you need to, and try to maintain a healthy weight. Take steps to reduce high blood pressure. Keep your low-density lipoprotein (LDL, or "bad") cholesterol and triglycerides — a type of blood fat — within recommended limits. Don't drink too much alcohol. If you have diabetes, your doctor may recommend an ultrasound examination of your liver when you're first diagnosed and regular follow-up blood tests to monitor your liver function. Continue reading >>

Type 2 Diabetes And Fatty Liver Disease

Type 2 Diabetes And Fatty Liver Disease

Non-alcoholic fatty liver disease is a group of conditions in which fat builds up in the liver, leading to inflammation of the cells where it is stored and causing the liver to get bigger. It can progress to more serious conditions, including fibrosis and cirrhosis of the liver. Fatty liver disease "is so common. It’s present arguably in a majority of type 2 diabetics,” says Daniel Einhorn, MD, clinical professor of medicine at the University of California, San Diego and the medical director of the Scripps Whittier Diabetes Institute. “None of us thought about it more than about 10 years ago, then all of a sudden we discovered it and see it all the time.” Fatty Liver Disease and Type 2 Diabetes: The Connection Diabetes does not cause fatty liver disease. Instead, the two diseases tend to occur in the same people because the same conditions cause both problems. “So, it’s not the diabetes per se. People with diabetes also have obesity and insulin resistance, and so the fatty liver is thought to be part of that,” Dr. Einhorn explains. Einhorn says that most cases of fatty liver disease do not cause any harm. However, since type 2 diabetes and obesity are so common in the United States, fatty liver disease is now a leading cause of end-stage (fatal) liver disease requiring a liver transplant, along with alcohol abuse and hepatitis. Fatty Liver Disease Diagnosis Fatty liver disease has no symptoms. People who are being treated for diabetes will have liver enzyme tests as part of their routine blood work during medical exams. Ninety-nine percent of the cases of fatty liver disease are detected by this test, says Einhorn. In some cases it will be picked up during the physical exam or in imaging studies, like a computed tomography scan of the abdomen or a liver ul Continue reading >>

Re-evaluation Of Glycated Hemoglobin And Glycated Albumin With Continuous Glucose Monitoring System As Markers Of Glycemia In Patients With Liver Cirrhosis

Re-evaluation Of Glycated Hemoglobin And Glycated Albumin With Continuous Glucose Monitoring System As Markers Of Glycemia In Patients With Liver Cirrhosis

Affiliations: Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga 8498501, Japan, Division of Hepatology, Liver Center, Saga Medical School, Saga 8498501, Japan Published online on: November 10, 2016 Copyright: Isoda et al. This is an open access article distributed under the terms of Creative Commons Attribution License. Metrics: HTML 0 views | PDF 0 views Cited By (CrossRef): 0 citations Liver cirrhosis (LC) is frequently accompanied by glucose intolerance. The present study was designed to determine whether glycated hemoglobinA1c (HbA1c) and glycated albumin (GA) were predictive markers of glycemia, as determined by a continuous glucose monitoring system (CGMS), in patients with LC. A total of 30patients with LC, including 3,19,5,2and1 with LC due to hepatitisB virus, hepatitisC virus, nonalcoholic steatohepatitis, alcohol and unknown causes, respectively, were assessed by CGMS. The average, maximum and minimum blood glucose (BG) levels were measured by CGMS, and correlated with HbA1c and GA. The average, maximum and minimum BG in these individuals were 14238.7, 209.365.7 and 85.125.4mg/dl, respectively. HbA1c was significantly correlated with average BG (r=0.447, P=0.015) and maximum BG (r=0.523, P=0.004). In addition, GA was significantly correlated with average BG (r=0.687, P<0.001) and maximum BG (r=0.648, P<0.001). Neither HbA1c nor GA was significantly correlated with minimum BG. Correlation analysis yielded formulas by which HbA1c and GA were predictive of average BG in individuals with LC: Average BG=19.2xHbA1c(%)+36.5 and average BG=6.6xGA (%)+13.0, respectively. In conclusion, HbA1c and GA showed significant correlations with average and maximum BG, as determined by CGMS. The derived formulas allow for estimates of average Continue reading >>

Metabolic Derangement In Acute And Chronic Liver Disorders Bajaj S, Kashyap R, Srivastava A, Singh S - Indian J Endocr Metab

Metabolic Derangement In Acute And Chronic Liver Disorders Bajaj S, Kashyap R, Srivastava A, Singh S - Indian J Endocr Metab

The liver plays a central role in carbohydrate, lipid and amino acid metabolism and is also involved in metabolizing of drugs and environmental toxins. Liver injury may be either acute or chronic. [1] The metabolic dysregulation associated with diabetes mellitus (DM) causes secondary pathophysiologic changes in multiple organ systems that impose a tremendous burden on the individual as well as the health system. Up to 96% of patients with cirrhosis may be glucose intolerant, and 30% may be clinically diabetic. [2] Currently, it is a matter for debate whether type 2 DM (T2DM), in the absence of other risk factors contributing to metabolic syndrome (obesity and hypertriglyceridemia), could be a risk factor for the development and progression of liver disease. [3] The liver has an important role in carbohydrate metabolism since it is responsible for the balance of blood glucose levels by means of glycogenesis and glycogenolysis. In the presence of hepatic disease, the metabolic homeostasis of glucose is impaired as a result of disorders such as insulin resistance (IR), glucose intolerance, and diabetes. IR occurs not only in muscular tissue, but also in adipose tissue, and this combined with hyperinsulinemia seem to be important pathophysiologic bases of diabetes in liver disease. [4] In addition, the etiology of liver disease is important in the incidence of DM, since nonalcoholic fatty liver disease (NAFLD), alcohol, hepatitis C virus (HCV), and hemochromatosis are frequently associated with DM. DM in patients with compensated liver cirrhosis may be subclinical, since fasting serum glucose levels may be normal. IR in muscular and adipose tissues and hyperinsulinemia seem to be the pathophysiologic basis of diabetes in liver disease. An impaired response of the islet -ce Continue reading >>

Relationship Between Hba1c And Chronic Glycemia In Patients With Cirrhosis

Relationship Between Hba1c And Chronic Glycemia In Patients With Cirrhosis

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Relationship Between HbA1c and Chronic Glycemia in Patients With Cirrhosis The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. ClinicalTrials.gov Identifier: NCT02389127 Information provided by (Responsible Party): Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information Cirrhosis and advanced liver disease have been associated with an increased risk for hyperglycemia and type 2 diabetes mellitus (T2DM). The diagnostic yield of common tests used to define diabetes and insulin resistance in the general population differs significantly from the one observed in patients with liver disease. Glycosylated hemoglobin A1c (HbA1c), a reliable test to assess chronic glycemia and recommended both for the diagnosis and monitoring of T2DM, is neither accurate nor reliable in patients with cirrhosis. A validation study has not been performed to define its true usefulness in the setting of cirrhosis. The study aims to determine the level of HbA1c that better corresponds to the diagnosis of T2DM - as determined by an oral glucose tolerance test (OGTT) - and to correlate the levels of HbA1c with the average glucose over a 12-week period in patients with cirrhosis and known T2DM, in cirrhotic patients with different degrees of liver impairment as compared to patients with T2DM and no liver disease. Device: Continuous glucose monitor (Dexcom, San Diego, CA) Relationship Between HbA1c and Chronic Glycemia in Patients With Cirrhosis: a Continue reading >>

What Does Liver Disease Have To Do With Diabetes?

What Does Liver Disease Have To Do With Diabetes?

The American College of Gastroenterology released new guidelines on liver chemistry tests in December 2016. Changed level recommendations were included for ALT- alanine aminotransferase, AST- aspartate aminotransferase, and alkaline phosphatase and bilirubin levels. In the past, ALT levels were accepted at a range from 30-40 IU/L and up to 70-80 IU/L while being hospitalized (body under stress). The new acceptable levels are 19-25 IU/L for women and 29-33IU/L for men. The vast change in “normal levels” of liver enzymes were updated since “multiple studies have demonstrated that if you have ALT levels even innocuously elevated, your risk of liver related death is significantly higher” according to Paul Kwo, MD from Stanford University. Liver disease can stem from alcohol, viral hepatitis A, B or C, genetic disorders, liver injury, drugs, supplements, Lyme disease and non-alcoholic fatty liver disease – NAFLD. Liver disease can often tell us about your overall health and liver function tests should be part of the work up utilized by your MD. What does this all mean for people with type 2 diabetes? What Does the Liver Do? The liver turns food into nutrients and filters toxins from the blood. The toxins include alcohol, medications, supplements, pollutants and insecticides. When the fat content of the liver reaches 10%, due to weight gain especially around the middle section and in visceral organs (internal fat), the spongy texture of the liver becomes coarse and the function declines. Liver problems begin. Non-Alcoholic Fatty Liver Disease – NAFLD Elevated ALT levels are common in people with pre-diabetes or diabetes and are often the first documented abnormal lab test, even prior to elevated fasting blood sugars or A1C values. NAFLD is common worldwide but muc Continue reading >>

Insulin Resistance And Chronic Liver Disease

Insulin Resistance And Chronic Liver Disease

Insulin resistance and chronic liver disease Takumi Kawaguchi , Eitaro Taniguchi , Minoru Itou , Masahiro Sakata , Shuji Sumie , and Michio Sata Takumi Kawaguchi, Michio Sata, Department of Disease Information & Research, Kurume University School of Medicine, Kurume 830-0011, Japan Takumi Kawaguchi, Eitaro Taniguchi, Minoru Itou, Masahiro Sakata, Shuji Sumie, Michio Sata, Department of Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan Author contributions: Kawaguchi T, Taniguch E, Itou M, Sakata M and Sumie S drafted the manuscript; Kawaguchi T and Sata M organized and revised the manuscript. Correspondence to: Takumi Kawaguchi, MD, PhD, Department of Digestive Disease Information & Research, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan. [email protected] Telephone: +81-942-31-7902 Fax: +81-942-31-7820 Received 2010 Nov 18; Revised 2011 Mar 26; Accepted 2011 Apr 2. Copyright 2011 Baishideng Publishing Group Co., Limited. All rights reserved. This article has been cited by other articles in PMC. Increased insulin resistance is frequently associated with chronic liver disease and is a pathophysiological feature of hepatogenous diabetes. Distinctive factors including hepatic parenchymal cell damage, portal-systemic shunting and hepatitis C virus are responsible for the development of hepatogenous insulin resistance/diabetes. Although it remains unclear whether insulin secretion from pancreatic beta cells is impaired as it is in type 2 diabetes, retinopathic and cardiovascular risk is low and major causes of death in cirrhotic patients with diabetes are liver failure, hepatocellular carcinoma and gastrointestinal hemorrhage. Hemoglobin A1c is an inaccurate marker for the assessment and management of hepatogenous Continue reading >>

Inaccuracies Of Hemoglobin A1c In Liver Cirrhosis: A Case Report

Inaccuracies Of Hemoglobin A1c In Liver Cirrhosis: A Case Report

Articles © The authors | Journal compilation © J Endocrinol Metab and Elmer Press Inc™ | www.jofem.org This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 30 Case Report J Endocrinol Metab. 2016;6(1):30-32 ressElmer Mathew Clarkea, Jamila Benmoussaa, Amulya Penmetsaa, b, Philip Otterbecka, Farhang Ebrahimia, Jay Nfonoyima Abstract Hemoglobin A1c (HbA1c) is the gold standard for the measurement of long-range glycemic control in patients with diabetes mellitus type 2 (T2DM). In a rare subset of patients, this measurement may not be reliable. Inaccuracies of HbA1c in liver cirrhosis are rare, but docu- mented. The objective of this study was to increase awareness about low HbA1c in liver cirrhosis and discuss alternative biomarkers that can be used to measure glycemic control. We present the case of a 61-year-old Caucasian female, with history of hepatitis C and uncon- trolled T2DM, who was admitted for evaluation of compensated liver cirrhosis. She was found to have blood glucoses greater than 500 mg/ dL; however, her HbA1c was measured at 5.5%. Ultrasound of the abdomen showed liver cirrhosis, ascites, and splenomegaly. Blood work revealed acute kidney injury, anemia of chronic disease, normal albumin level, and low HbA1c. Fructosamine and glycated albumin were high, indicating a hyperglycemic status during the last 3 weeks. HbA1c can be falsely low in liver cirrhosis, and can give a false as- sumption about control of the diabetic disease process. In this case, other biomarkers can be used to monitor glycemic control; by far fre- quent fing Continue reading >>

When The A1c Is Unreliable

When The A1c Is Unreliable

Although hemoglobin A1c is usually the best test to estimate the average glycemic control in patients with diabetes, it is unreliable in some clinical circumstances. In select patient populations, measuring fructosamine and glycated albumin levels may also be useful. _______________________________________________________________________________________________________________________________________________________ Related Content Diabetes and Cardiovascular Disease: Does Lowering Hemoglobin A1c Help or Harm? Structured Diet Plan Improves A1c in Type 2 Diabetes _____________________________________________________________________________________________________________________________________________________ Q1. What is the A1c and why is it important? A: A1c represents the percent of hemoglobin A with glucose bound to it. While the percent is normally low, in diabetics the higher glucose circulating in the blood causes more hemoglobin binding which results in a higher A1c level. It also can correlate with average glycemic control during the past 2 to 3 months. The American Diabetes Association recommends measuring A1c—≥ 6.5% (48mmol/mol)—as a diagnostic criterion for diabetes and quantifying A1c as the standard laboratory assessment to determine control of type 1 and type 2 diabetes.1 Since the publication of the Diabetes Control and Complications Trial in 1993, we know that A1c levels also directly correlate to the risk of developing diabetic complications such as retinopathy, neuropathy and nephropathy.2 Q2. When is the A1c unreliable? A: For A1c standard test results to be reliable, normal adult hemoglobin A must be present for glucose binding. However, a number of clinically significant disorders alter hemoglobin either structurally or chemically thereby aff Continue reading >>

Spectrum Of Liver Disease In Type 2 Diabetes And Management Of Patients With Diabetes And Liver Disease

Spectrum Of Liver Disease In Type 2 Diabetes And Management Of Patients With Diabetes And Liver Disease

It is estimated that 20.8 million people, i.e., 7.0% of the U.S. population, have diabetes (1). Type 2 diabetes, with its core defects of insulin resistance and relative insulin deficiency, accounts for 90–95% of those with the disease. Another 5.2 million people are estimated to have undiagnosed type 2 diabetes. It is the sixth leading cause of death (1) in the U.S. and accounts for 17.2% of all deaths for those aged >25 years (2). Liver disease is an important cause of death in type 2 diabetes. In the population-based Verona Diabetes Study (3), cirrhosis was the fourth leading cause of death and accounted for 4.4% of diabetes-related deaths. The standardized mortality ratio (SMR), i.e., the relative rate of an event compared with the background rate, for cirrhosis was 2.52 compared with 1.34 for cardiovascular disease (CVD). In another prospective cohort study (4), cirrhosis accounted for 12.5% of deaths in patients with diabetes. Diabetes, by most estimates, is now the most common cause of liver disease in the U.S. Cryptogenic cirrhosis, of which diabetes is, by far, the most common cause, has become the third leading indication for liver transplantation in the U.S. (5,6). Virtually the entire spectrum of liver disease is seen in patients with type 2 diabetes. This includes abnormal liver enzymes, nonalcoholic fatty liver disease (NAFLD), cirrhosis, hepatocellular carcinoma, and acute liver failure. In addition, there is an unexplained association of diabetes with hepatitis C. Finally, the prevalence of diabetes in cirrhosis is 12.3–57% (7). Thus, patients with diabetes have a high prevalence of liver disease and patients with liver disease have a high prevalence of diabetes. The management of diabetes in patients with liver disease is theoretically complicated b Continue reading >>

How Reliable Is Hemoglobin A1c?

How Reliable Is Hemoglobin A1c?

Peer Reviewed According to the CDC, there are 22 million people with an established diagnosis of diabetes mellitus in the United States, but more frightening is that the rate of diabetes continues to rise both nationally and globally, with predictions that 7.7% of the world’s adult population will be afflicted with the disease in 2030.[1],[2] Preventing, monitoring, and managing this disease is of utmost importance in responding to the growing epidemic. The hemoglobin A1c (HbA1c) blood test has become a powerful tool in this effort, but it is imperative that healthcare providers be aware of both its strengths and limitations. Diabetes is currently diagnosed in one of four ways: –Fasting plasma glucose ≥126 mg/dL –Two-hour oral glucose tolerance test plasma glucose ≥200 mg/dL –HbA1c of ≥6.5%, –Random plasma glucose of ≥200 mg/dL with symptoms of hyperglycema.[3] For each test, a positive result needs to be repeated for confirmation unless the diagnosis of diabetes is obvious. HbA1c has several advantages over the other tests. It is a measure of glycemia over a 2-3 month period and sheds more light on overall glucose levels than a single plasma glucose measurement. Consequently, it does not require fasting and is unaffected by acute perturbations like stress or recent exercise. In addition to convenience, the pre-analytic stability of HbA1c is superior to that of the plasma glucose test.[4] After blood is drawn and centrifuged, glucose consumption occurs and glucose concentration decreases at 5% to 7% per hour, with a greater rate at higher temperatures.[5], [6] Often, blood samples are processed hours after withdrawal and, as a result, glucose readings are falsely lowered. The pre-analytical variability of fasting plasma glucose is 5% to 10%, while the Continue reading >>

Challenges In Diagnosing And Monitoring Diabetes In Patients With Chronic Liver Diseases - Sciencedirect

Challenges In Diagnosing And Monitoring Diabetes In Patients With Chronic Liver Diseases - Sciencedirect

Challenges in diagnosing and monitoring diabetes in patients with chronic liver diseases Author links open overlay panel Telma E.Silvaa Get rights and content The prevalence and mortality of diabetes mellitus and liver disease have risen in recent years. The liver plays an important role in glucose homeostasis, and various chronic liver diseases have a negative effect on glucose metabolism with the consequent emergence of diabetes. Some aspects related to chronic liver disease can affect diagnostic tools and the monitoring of diabetes and other glucose metabolism disorders, and clinicians must be aware of these limitations in their daily practice. In cirrhotic patients, fasting glucose may be normal in up until 23% of diabetes cases, and glycated hemoglobin provides falsely low results, especially in advanced cirrhosis. Similarly, the performance of alternative glucose monitoring tests, such as fructosamine, glycated albumin and 1,5-anhydroglucitol, also appears to be suboptimal in chronic liver disease. This review will examine the association between changes in glucose metabolism and various liver diseases as well as the particularities associated with the diagnosis and monitoring of diabetes in liver disease patients. Alternatives to routinely recommended tests will be discussed. Continue reading >>

What Clinical Laboratorians Should Do In Response To Extremely Low Hemoglobin A1c Results

What Clinical Laboratorians Should Do In Response To Extremely Low Hemoglobin A1c Results

Extremely low hemoglobin A1c (HbA1c) results below reference range are rare, and the causes and clinical implications associated with low HbA1c results are not well understood among clinical laboratorians. A case of extremely low HbA1c results was reported, in which liver cirrhosis, subacute hemorrhage and recent transfusion all contributed to the low result. This case illustrates when HbA1c should not be used as a clinically relevant diabetes marker. However, low or extremely low HbA1c (<5.0% or <4.0%) may occur in apparently healthy individuals. When this occurs, it is an independent risk factor associated with liver diseases, hospitalization, and all-cause mortality. From the clinical laboratory perspective, the clinical cause of extremely low HbA1c should be determined, and suggestions of different test utilization or increased health surveillance should be given to care providers. Continue reading >>

Glucose Homeostasis In Cirrhosis: Accuracy Of Hemoglobin A1c And Potential Usefulness Of Continuous Glucose Monitoring

Glucose Homeostasis In Cirrhosis: Accuracy Of Hemoglobin A1c And Potential Usefulness Of Continuous Glucose Monitoring

ABSTRACT FINAL ID: 1411 TITLE: Glucose homeostasis in cirrhosis: accuracy of hemoglobin a1c and potential usefulness of continuous glucose monitoring SPONSORSHIP - THIS STUDY WAS SPONSORED BY: (IF THIS ABSTRACT WAS NOT SPONSORED PLEASE INDICATE): Sturgis Diabetes Foundation ABSTRACT BODY: Background & Aims: The oral glucose tolerance test (OGTT) improves detection of glucose homeostasis disorders in cirrhosis. Little is known about the accuracy of HbA1c to detect prediabetes and type 2 diabetes mellitus (T2DM) or to monitor existing T2DM in patients with cirrhosis. Continuous glucose monitoring (CGM) measures blood glucose (BG) every 5 minutes. We aimed to compare the diagnostic yield of HbA1c against OGTT and its usefulness in monitoring T2DM when compared to CGM-BG. Methods: Cirrhotics without (Group A) and with (Group B) T2DM were screened. We performed OGTT in Group A, and blinded, monthly CGM (Dexcom G4) for 3-7 days, over 3 months in Group B. HbA1c, fructosamine, and fasting routine labs were evaluated in all patients (end of study in Group B). CGM-BG was validated with glucose meter (GM-BG; Freestyle, Abbott). We calculated indices of hypoglycemia (LBGI: low BG index) and BG variation (BGRI: BG risk index) from CGM-BG determinations. Results: We included 21 cirrhotics in Group A and 14 in B (age 57±9, 66% males). Main etiologies: HCV (43%), NASH (26%) and alcohol (23%). BMI was 33±7, Hb 14±2, and 43% were decompensated. Fasting BG correlated both with HbA1c (r2=0.44, p<0.001) and fructosamine (r2=0.43, p=0.008) in all patients. In Group A, OGTT identified 10 (48%) cases of prediabetes and 3 (14%) of T2DM; whereas, HbA1c identified 5 (24%) and 3 (14%), respectively (kappa=0.37, p=0.01). In Group B, each subject had an average of 3284±1225 BG determinations. Me Continue reading >>

Case Study: Diabetes In A Patient With Cirrhosis

Case Study: Diabetes In A Patient With Cirrhosis

Case Study: Diabetes in a Patient With Cirrhosis J.T. is a 72-year-old man with chronic hepatitis C and Child-Pugh grade A (clinically well-compensated) cirrhosis. He takes propranolol for esophageal variceal bleeding prophylaxis. He had a blood transfusion 25 years ago. Hepatitis C was diagnosed 10 years ago, and cirrhosis was diagnosed by liver biopsy 2 years ago. He does not drink alcohol. He has never been overweight. He has no personal or family history of diabetes. Over the past year, random plasma glucose levels have ranged from 110 to 180 mg/dl. The most recent random glucose was 210 mg/dl. The patient denies polydipsia, polyuria, nocturia, or any other symptoms of hyperglycemia. He weighs 150 lb (BMI 22 kg/m Physical examination findings are normal except for mild palmar erythema, spider angiomata on the upper chest, and a palpable spleen tip. Fasting blood glucose was 136 mg/dl, and a hemoglobin A1c (A1C) was 6.3%. Another fasting glucose several weeks later was 128 mg/dl. Should medication be started to treat hyperglycemia? How does the diagnosis of diabetes affect this patients prognosis? At first glance, many clinicians might assume this patient has type 2 diabetes. The history is compatible with this diagnosis. However, the absence of classic risk factors for type 2 diabetes and the appearance of new hyperglycemia in the setting of known cirrhosis makes it more likely he has liver diabetes, also known as hepatogenous diabetes.1,2 Patients with cirrhosis have insulin resistance. Impaired glucose tolerance (IGT) is common, and about 2040% have diabetes.1,3 While there is no definitive test to distinguish type 2 diabetes from diabetes caused by liver disease, liver diabetes appears to be caused by hepatic dysfunction. It should be noted that the American Dia Continue reading >>

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