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Hepatogenous Diabetes

Diagnostic Significance Of Diabetes In Liver Cirrhosis

Diagnostic Significance Of Diabetes In Liver Cirrhosis

Diagnostic significance of diabetes in liver cirrhosis Abstract: Alterations in carbohydrate metabolism are frequently observed in cirrhosis, and approximately 15% to 30% of patients have overt diabetes. The aim of the present study was to examine the clinical implications and the prognostic significance of hepatogenous diabetes in patients with liver cirrhosis. In a retrospective and prospective study in cirrhosis; we analyzed the prognostic significance of diabetes, which was defined as the presence of hyperglycemia and overt glycosuria that in most cases required dietary restrictions or active treatment. The prospective cohort study was conducted in 76 patients with histologically confirmed liver cirrhosis. The examination included a history, determination of basal C-peptide and glycosylated hemoglobin (HbA1c) and, in some cases, a 3 hours oral glucose tolerance test with 100 g glucose. The clinical records of all patients with cirrhosis admitted to Govt City Hospital, Bilaspur and CIMS, Bilaspur for the period 2011 to 2016 were reviewed in 2016 and surviving patients were prospectively followed up until December 2016. Final status could be obtained in 76 (41 with diabetes); 63 were alive at the end of follow-up. The model identified, in sequence, albumin, ascites, age, bilirubin, serum Glucose and platelets as prognostic factors. The larger mortality rate in patients with diabetes was not due to complications of diabetes but to an increased risk of hepatocellular failure. Thus, the presence of diabetes, clinically detectable and often requiring adequate treatment is a risk factor for long-term survival in cirrhosis. Fifty Four percent of patients with liver cirrhosis had manifest diabetes, 41% had impaired glucose tolerance and only 5% had normal glucose tolerance. Continue reading >>

Hepatogenous Diabetes: Is It Time To Separate It From Type 2 Diabetes?

Hepatogenous Diabetes: Is It Time To Separate It From Type 2 Diabetes?

Hepatogenous diabetes: Is it time to separate it from type 2 diabetes? Emanuela Orsi - IRCCS C GrandaOspedale Maggiore Policlinico Foundation University of Milan Diabetes Service Milan Italy, University of Milan Valeria Grancini - IRCCS C GrandaOspedale Maggiore Policlinico Foundation University of Milan Diabetes Service Milan Italy, University of Milan Stefano Menini - Sapienza University of Rome, Azienda Ospedaliera Sant'Andrea Alessio Aghemo - IRCCS C GrandaOspedale Maggiore Policlinico Foundation University of Milan Division of Gastroenterology and Hepatology Milan Italy Giuseppe Pugliese - Sapienza University of Rome, Azienda Ospedaliera Sant'Andrea By definition, hepatogenous diabetes is directly caused by loss of liver function, implying that it develops after cirrhosis onset. Therefore, it should be distinguished from type 2 diabetes developing before cirrhosis onset, in which specific causes of liver disease play a major role, in addition to traditional risk factors. Currently, although hepatogenous diabetes shows distinct pathophysiological and clinical features, it is not considered as an autonomous entity. Recent evidence suggests that the failing liver exerts an independent "toxic" effect on pancreatic islets resulting in -cell dysfunction. Moreover, patients with hepatogenous diabetes usually present with normal fasting glucose and haemoglobin A1c levels and abnormal response to an oral glucose tolerance test, which is therefore required for diagnosis. This article discusses the need to separate hepatogenous diabetes from type 2 diabetes occurring in subjects with chronic liver disease and to identify individuals suffering from this condition for prognostic and therapeutic purposes. 2018 Digital Science & Research Solutions, Inc. All Rights Reserved | Abo Continue reading >>

Hepatogenous Diabetes In Cirrhosis Is Related To Portal Pressure And Variceal Hemorrhage

Hepatogenous Diabetes In Cirrhosis Is Related To Portal Pressure And Variceal Hemorrhage

, Volume 58, Issue11 , pp 33353341 | Cite as Hepatogenous Diabetes in Cirrhosis Is Related to Portal Pressure and Variceal Hemorrhage 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. 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, 53.010.2years) 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. 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 ChildPughs score, variceal hemorrhage, and HVPG (p=0.004, 0.002, and 0.019, respectively). In multivariate analysis, ChildPughs score (OR 1.43, 95% CI 1.0052.038) and HVPG (OR 1.15, 95% CI 1.0032.547) had significant relationships with HD. Patients with recent variceal hemorrhages (within 6months) exhibited significantly higher glucose levels at 120min 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). HD and IR have significant relationships with PHT and variceal hemorrhage. Postprandial hyperglycemia in particular had a significa Continue reading >>

Hepatogenous Diabetes: Is It Time To Separate It From Type 2 Diabetes?

Hepatogenous Diabetes: Is It Time To Separate It From Type 2 Diabetes?

1. Liver Int. 2017 Jul;37(7):950-962. doi: 10.1111/liv.13337. Epub 2016 Dec 31. Hepatogenous diabetes: Is it time to separate it from type 2 diabetes? Orsi E(1)(2), Grancini V(1)(2), Menini S(3)(4), Aghemo A(5), Pugliese G(3)(4). (1)Diabetes Service, Endocrinology and Metabolic Diseases Unit, IRCCS "C Granda-Ospedale Maggiore Policlinico" Foundation, University of Milan, Milan, Italy. (2)Department of Medical Sciences, University of Milan, Milan, Italy. (3)Department of Clinical and Molecular Medicine, "La Sapienza" University, Rome, Italy. (4)Diabetes Unit, Sant'Andrea Hospital, Rome, Italy. (5)Division of Gastroenterology and Hepatology, A.M. and A. Migliavacca Center for Liver Disease, IRCCS "C Granda-Ospedale Maggiore Policlinico" Foundation, University of Milan, Milan, Italy. By definition, hepatogenous diabetes is directly caused by loss of liverfunction, implying that it develops after cirrhosis onset. Therefore, it shouldbe distinguished from type 2 diabetes developing before cirrhosis onset, in whichspecific causes of liver disease play a major role, in addition to traditionalrisk factors. Currently, although hepatogenous diabetes shows distinctpathophysiological and clinical features, it is not considered as an autonomousentity. Recent evidence suggests that the failing liver exerts an independent"toxic" effect on pancreatic islets resulting in -cell dysfunction. Moreover,patients with hepatogenous diabetes usually present with normal fasting glucoseand haemoglobin A1c levels and abnormal response to an oral glucose tolerancetest, which is therefore required for diagnosis. This article discusses the need to separate hepatogenous diabetes from type 2 diabetes occurring in subjects withchronic liver disease and to identify individuals suffering from this condit Continue reading >>

Relationships Between Mean Plasma Glucose And Hba1c In Cirrhotic Patients With Hepatogenous Diabetes

Relationships Between Mean Plasma Glucose And Hba1c In Cirrhotic Patients With Hepatogenous Diabetes

You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Relationships Between Mean Plasma Glucose and HbA1c in Cirrhotic Patients With Hepatogenous Diabetes 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: NCT02325622 Verified December 2014 by Moon Young Kim, Yonsei University. Information provided by (Responsible Party): Study Description Study Design Groups and Cohorts Outcome Measures Eligibility Criteria Contacts and Locations More Information The liver plays a crucial role in physiological glycemic control through its involvement in several glucose metabolism processes, including glycogenogenesis and glycogenolysis. Liver diseases result in impaired glucose metabolism due to hepatocyte dysfunction, termed as "hepatogenous diabetes". Abnormal glucose metabolism is found in over 90% of patients with liver cirrhosis. and clinically significant diabetes is known to occur in 30% to 70% of the patients. A cohort study of cirrhotic patients with hepatogenous diabetes reported a relatively low diabetic complication rate, and the majority of mortality causes were complications related to liver cirrhosis; furthermore, mortality rate due to diabetic complications were reported to be low. Nonetheless, the average survival rate following the diagnosis of liver cirrhosis is rising due to increasing early detection rate and improvements in treatment modalities, and such rise in survival is expected to result in increased prevalence of hepatogenous diabetes and its complications. Therefore, it is necessary to formula Continue reading >>

Clinical Implications Of Hepatogenous Diabetes In Liver Cirrhosis

Clinical Implications Of Hepatogenous Diabetes In Liver Cirrhosis

Clinical implications of hepatogenous diabetes in liver cirrhosis Andreas Holstein, S Hinze, E Thiessen, A Plaschke, E-H Egberts Journal of Gastroenterology and Hepatology 2002, 17 (6): 677-81 BACKGROUND: Hepatogenous diabetes is a common complication of liver cirrhosis. The aim of the present study was to examine the clinical and therapeutic implications and the prognostic significance of hepatogenous diabetes in patients with liver cirrhosis. METHODS: The prospective cohort study was conducted in 52 patients with histologically confirmed liver cirrhosis (44% Child A, 37% Child B, 19% Child C). The examination included a history, determination of basal C-peptide and glycosylated hemoglobin (HbA(1c)) and, in some cases, a 3 h oral glucose tolerance test with 100 g glucose. Patients were also examined for signs of diabetic retinopathy and information on the further course of illness was obtained. RESULTS: Seventy-one percent of patients with liver cirrhosis had manifest diabetes, 25% had impaired glucose tolerance and only 4% had normal glucose tolerance. In most cases, the hepatogenous diabetes was clinically asymptomatic. Sixteen percent of patients with hepatogenous diabetes had a family history of diabetes; only 8% had retinopathic complications. Within 5.6 +/- 4.5 years after diagnosis of liver cirrhosis, 52% of the diabetics had died, mainly of complications of the cirrhosis. There were no diabetes-associated or cardiovascular deaths. CONCLUSIONS: Hepatogenous diabetes differs from type 2 diabetes in that there is less often a positive family history and that the cardiovascular and retinopathic risk is low. The prognosis of cirrhotic patients with diabetes is more likely to be negatively affected by the underlying hepatic disease and its complications than by the Continue reading >>

A Synthetic-biology-inspired Therapeutic Strategy For Targeting And Treating Hepatogenous Diabetes - Sciencedirect

A Synthetic-biology-inspired Therapeutic Strategy For Targeting And Treating Hepatogenous Diabetes - Sciencedirect

A Synthetic-Biology-Inspired Therapeutic Strategy for Targeting and Treating Hepatogenous Diabetes Hepatogenous diabetes is a complex disease that is typified by the simultaneous presence of type 2 diabetes and many forms of liver disease. The chief pathogenic determinant in this pathophysiological network is insulin resistance (IR), an asymptomatic disease state in which impaired insulin signaling in target tissues initiates a variety of organ dysfunctions. However, pharmacotherapies targeting IR remain limited and are generally inapplicable for liver disease patients. Oleanolic acid (OA) is a plant-derived triterpenoid that is frequently used in Chinese medicine as a safe but slow-acting treatment in many liver disorders. Here, we utilized the congruent pharmacological activities of OA and glucagon-like-peptide 1 (GLP-1) in relieving IR and improving liver and pancreas functions and used a synthetic-biology-inspired design principle to engineer a therapeutic gene circuit that enables a concerted action of both drugs. In particular, OA-triggered short human GLP-1 (shGLP-1) expression in hepatogenous diabetic mice rapidly and simultaneously attenuated many disease-specific metabolic failures, whereas OA or shGLP-1 monotherapy failed to achieve corresponding therapeutic effects. Collectively, this work shows that rationally engineered synthetic gene circuits are capable of treating multifactorial diseases in a synergistic manner by multiplexing the targeting efficacies of single therapeutics. Continue reading >>

Hepatogenous Diabetes: Is It A Neglected Condition In Chronic Liver Disease?

Hepatogenous Diabetes: Is It A Neglected Condition In Chronic Liver Disease?

Hepatogenous diabetes: Is it a neglected condition in chronic liver disease? Diego Garca-Compen , Jos Alberto Gonzlez-Gonzlez , Fernando Javier Lavalle-Gonzlez , Emmanuel Irineo Gonzlez-Moreno , Jess Zacaras Villarreal-Prez , and Hctor Jess Maldonado-Garza Diego Garca-Compen, Jos Alberto Gonzlez-Gonzlez, Emmanuel Irineo Gonzlez-Moreno, Hctor Jess Maldonado-Garza, Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. Jos E. Gonzlez and Medical School, Universidad Autnoma de Nuevo Len, Monterrey 64320, Mxico Fernando Javier Lavalle-Gonzlez, Jess Zacaras Villarreal-Prez, Endocrinology Service and Department of Internal Medicine, University Hospital Dr. Jos E. Gonzlez and Medical School, Universidad Autnoma de Nuevo Len, Monterrey 64320, Mxico Author contributions: All the authors contributed equally to the revision of the content of this manuscript; and Garca-Compen D conceived and wrote the editorial. Correspondence to: Diego Garca-Compen, MD, MMSc, Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. Jos E. Gonzlez and Medical School, Universidad Autnoma de Nuevo Len, Madero y Gonzalitos S/N, Monterrey 64320, Mxico. [email protected] Telephone: +52-81-83487315 Fax: +52-81-89891381 Received 2015 Dec 23; Revised 2016 Jan 20; Accepted 2016 Feb 20. Copyright The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved. This article has been cited by other articles in PMC. Diabetes mellitus (DM) that occurs because of chronic liver disease (CLD) is known as hepatogenous diabetes (HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk Continue reading >>

Frequency Of Diabetes In Hepatitis

Frequency Of Diabetes In Hepatitis

Musleh Uddin Kalar1*, Ali Abbas Mohsin Ali2, Sidra Ali2, Syed Monis Ul Hasan2, Syeda Jabeen Zahra Kazmi2, Khusboo-e-Fatima2, Huda Zainab Hasan2 and Syed Zohaib Ahsan3 Senior Registrar MBBS, MPH, (USA). Department of Community Health Sciences, Karachi Medical & Dental College, Pakistan Final year Medical student, Sindh Medical College, Dow University of Health Sciences, Pakistan House Officer, Jinnah Postgraduate Medical Center, Pakistan Corresponding Author: Musleh Uddin Kalar MBBS, MPH, (USA) Senior Registrar, Department of Community Health Sciences Karachi Medical & Dental College, Pakistan, Email: [emailprotected] , Tel: 9221 03312587070, Fax: 009221 36675655 Related article at Pubmed , Scholar Google Visit for more related articles at International Journal of Collaborative Research on Internal Medicine & Public Health Introduction: The presence of hepatitis and diabetes is a known factor. Insulin resistance in muscular, hepatic and adipose tissues as well as hyperinsulinemia, seem to be pathophysiologic bases for hepatogenous diabetes. World Health Organization (WHO) ranks Pakistan 7th on diabetes prevalence list. Objective: The objective of this study was to determine the prevalence of type 2 diabetes in chronic liver disease. Methods: The descriptive cross-sectional survey based study was carried out at public sector government hospitals of Karachi, Pakistan. Patients with positive diagnosis of hematologic parameters were included. ANOVA was conducted to observe the difference between the clinical parameters between hepatitis B and C. Data was normally distributed as evaluated by Shapiro- Wilk test (p > 0.05). The study protocol was approved by ethical review committee. Results: The two groups of hepatitis B and C showed statistically significant difference when Continue reading >>

Hepatogenous Diabetes. Current Views Of An Ancient Problem.

Hepatogenous Diabetes. Current Views Of An Ancient Problem.

Hepatogenous diabetes. Current views of an ancient problem. Department of Gastroenterology, Hospital Universitario. Ave. Madero y Gonzalitos, Col. Mitras Centro, Monterrey 64700, Mexico. [email protected] Diabetes developed as a complication of cirrhosis is known as hepatogenous diabetes>> (HD). Around 30% to 60% of cirrhotic patients suffer from this metabolic disorder. Insulin resistance in muscular, hepatic and adipose tissues as well as hyperinsulinemia, seem to be pathophysiologic bases for HD. An impaired response of the islet ss-cells of the pancreas and the hepatic insulin resistance are also contributing factors. Diabetes develops when defective oxidative and nonoxidative muscle glucose metabolism develops. Non-alcoholic fatty liver disease (NAFLD), alcoholic cirrhosis, chronic hepatitis C (CHC), and hemochromatosis are more frequently associated with HD. HD in early cirrhosis stages may be sub clinical. Only insulin resistance and glucose intolerance may be observed. As liver disease advances, diabetes becomes clinically manifest, therefore HD may be considered as a marker for liver function deterioration. HD is clinically different from that of type 2 DM since it is less frequently associated with microangiopathy and patients suffer complications of cirrhosis more frequently as well as increased mortality. Insulin resistance and HD associate to a decrease in the sustained response to antiviral therapy and an increased progression of fibrosis in patients with CHC. Diabetes treatment is complex due to liver damage and hepatotoxicity of oral hypoglycemic drugs that are frequently prescribed to these patients. This paper will review current concepts in relation to the pathopysiology, the impact on the clinical outcome of cirrhosis, and the therapy o Continue reading >>

Diabetes And Liver An Association: Hepatogenous Diabetes Mechanism And Some Evidences

Diabetes And Liver An Association: Hepatogenous Diabetes Mechanism And Some Evidences

Ajita Acharya, Eden Wudneh, Radhika Krishnan, Aisha Ashraf and Hassaan Tohid* California Institute of Behavioral Neurosciences and Psychology (The Neuro/Cal Institute), University of California, Davis, USA *Corresponding Author: Tohid H, California Institute of Behavioral Neurosciences and Psychology (The Neuro-Cal Institute), 4751 Mengels Blvd, Fairfield, California, 94534, USA, Tel: 707-999-1268; E-mail: [email protected] Citation: Acharya A, Wudneh E, Krishnan R, Ashraf A, Tohid H (2016) Diabetes and Liver an Association: Hepatogenous Diabetes Mechanism and Some Evidences. J Cell Sci Ther 7:257. doi: 10.4172/2157-7013.1000257 Copyright: © 2016 Acharya A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Cell Science & Therapy Abstract A literature search was conducted in different databases to study the topic of liver problems and diabetes. The aim of the study was to explore more about an association of diabetes mellitus with the liver. The study shows that diabetes does indeed have an effect on liver. Similarly, liver problems like chronic liver disease lead to diabetes which is known as hepatogenous diabetes. Common liver problems seen in diabetes patients include but not limited to fatty liver, decreased glycogen levels, risk of liver cancer etc. Like any medical problem, any knowledge about any subject is never enough, therefore we recommend more studies in the near future to broaden our understanding about the association of the liver with diabetes. Keywords Diabetes; Diabetes complications; Diabetes and liver; Diabete Continue reading >>

Diabetes And Liver

Diabetes And Liver

1. Diabetes and Liver 2. Outline 1. Diabetes and liver -? Vicious cycle 2.Hepatogenous diabetes 3.Elevated transaminases 4.Which agent 3. 1. Diabetes and liver -? Vicious cycle 2.Hepatogenous diabetes 3.Elevated transaminases 4.Which agent 4. The putative mechanisms underlying the contribution of NAFLD to the increased risk of developing CVD and T2DM Anstee, Q. M. et al. (2013) Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2013.41 5. Anstee, Q. M. et al. (2013) Progression of NAFLD to diabetes mellitus, cardiovascular disease or irrhosis Nat. Rev. Gastroenterol. Hepatol. doi:10.1038/nrgastro.2013.41 6. 1. Diabetes and liver -? Vicious cycle 2.Hepatogenous diabetes 3.Elevated transaminases 4.Which agent 7. Hyperinsulinaemia Down regulation of insulin receptors 8. • Hepatogenous diabetes differs from type 2 diabetes in that there is less often a positive family history and that the cardiovascular and retinopathic risk is low. • The prognosis of cirrhotic patients with diabetes is more likely to be negatively affected by the underlying hepatic disease and its complications than by the diabetes. 9. • Liver transplantation did not correct the diabetes in one-third of patients with hepatogenous diabetes undergoing transplantation. • HbA 1c is an unreliable - undetected bleeding episodes - hemolysis due to hypersplenism are frequent in • Using a fructosamine test in addition to blood glucose self-monitoring may provide a more suitable assessment of metabolic control. 10. • no dietary restrictions should be prescribed for patients with hepatogenous diabetes. The survival of patients with liver cirrhosis depends on an adequate calorie intake; a hypocaloric diet even leads to incre Continue reading >>

The Successful Treatment Of Hepatogenous Diabetes Due To Alcoholic Liver Cirrhosis With Thrice-daily Preprandial Exenatide, A Short-acting Glp-1 Analog: A Case Report

The Successful Treatment Of Hepatogenous Diabetes Due To Alcoholic Liver Cirrhosis With Thrice-daily Preprandial Exenatide, A Short-acting Glp-1 Analog: A Case Report

The Successful Treatment of Hepatogenous Diabetes Due to Alcoholic Liver Cirrhosis With Thrice-Daily Preprandial Exenatide, a Short-Acting GLP-1 Analog: A Case Report Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Science Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Science Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Science Released on J-STAGE: July 30, 2017 [Advance Publication] Released: - Received: December 20, 2016 Revised: - Accepted: March 21, 2017 We describe the case of a 67-year-old man with hepatogenous diabetes caused by alcoholic cirrhosis. He was admitted to our hospital due to hyperglycemia (HbA1c 9.4 %) and basal-bolus-therapy was initiated. Although the dose of insulin lispro was increased to 64 U/day, the patient's postprandial hyperglycemia persisted due to insulin resistance, which was associated with cirrhosis. Insulin was discontinued because the patient had allergic reactions to insulin at the injection site during insulin therapy and liraglutide and voglibose combination therapy was started. However, the patient's post-lunch and post-dinner hyperglycemia showed no improvement. Thus, exenatide treatment (three daily injections before each meal) was started. Therea Continue reading >>

Prime Pubmed | [hepatogenous Diabetes - Diagnostics And Treatment

Prime Pubmed | [hepatogenous Diabetes - Diagnostics And Treatment

Gundling F, Schumm-Draeger PM, Schepp W: "[Hepatogenous diabetes - diagnostics and treatment]." Zeitschrift fr Gastroenterologie, vol. 47, no. 5, 2009, pp. 436-45, Accessed June 24, 2018. Gundling F, Schumm-Draeger PM, Schepp W. [Hepatogenous diabetes - diagnostics and treatment]. Z Gastroenterol 2009;47(5):436-45 Accessed June 24, 2018. Gundling F & Schumm-Draeger PM & Schepp W. (2009). [Hepatogenous diabetes - diagnostics and treatment]. Zeitschrift fr Gastroenterologie, 47, pp. 436-45. doi:10.1055/s-0028-1109200 Gundling F, Schumm-Draeger PM, Schepp W. [Hepatogenous diabetes - diagnostics and treatment]. Z Gastroenterol. 2009;47:436-45 TY - JOURT1 - [Hepatogenous diabetes - diagnostics and treatment].AU - Gundling,F,AU - Schumm-Draeger,P M,AU - Schepp,W,Y1 - 2009/05/05/PY - 2009/5/5/epublishPY - 2009/5/7/entrezPY - 2009/5/7/pubmedPY - 2009/8/1/medlineSP - 436EP - 45JF - Zeitschrift fr GastroenterologieJO - Z GastroenterolVL - 47IS - 5N2 - BACKGROUND: Patients with liver cirrhosis develop frequently disturbances of glucose metabolism e. g. glucose intolerance or hepatogenous diabetes which are caused by the hepatocellular functional loss and insulin resistance due to chronic liver disease. DISCUSSION: Until now there are no recommendations comparable to guidelines on the diagnosis of and therapy for hepatogenic diabetes. Regarding basic treatment a sufficient daily energy and protein supply should be guaranteed since the majority of patients with liver cirrhosis are malnourished. The risk of hypoglycaemia must be considered carefully under pharmacological treatment of hepatogenous diabetes. Biguanide and PPAR gamma agonists are contraindicated due to side effects in liver cirrhosis. Suitable oral antidiabetics are glinides and short-acting sulfonylureas. If a suffici Continue reading >>

Diabetes In Chronic Liver Disease

Diabetes In Chronic Liver Disease

Researchers in Vienna have made a breakthrough with synthetic bile acids in the treatment of primary sclerosing cholangitis. These compounds could feasibly be of use in fatty liver and diabetes – but would require further study. “Bile acids are not only involved in the secretion of bile fluids and fat digestion, but also have hormone-like effects, particularly on the regulation of fat and glucose metabolism in the liver. Researchers at the MedUni Vienna are currently also investigating what role these effects of Nor-Urso [norursodeoxycholic acid] and other bile acid derivatives play in the treatment of fatty liver, diabetes, fat metabolism problems and arteriosclerosis and how they could replace current conventional treatment methods and drugs.” This news is interesting and it reminds us of the strong link between diabetes and the liver. What is this relationship and what are the implications for clinical practice? The liver plays an important role in the regulation of glucose homeostasis. This helps explain why glucose intolerance is a feature or complication of chronic liver disease and cirrhosis. Liver disease associated with diabetes mellitus can be divided into three groups as shown below [1]: 1. Liver disease occurring as a consequence of diabetes mellitus • Glycogen deposition • Steatosis and nonalcoholic steatohepatitis (NASH) • Fibrosis and cirrhosis • Biliary disease, cholelithiasis, cholecystitis • Complications of therapy of diabetes (cholestatic and necroinflammatory) 2 . Diabetes mellitus and abnormalities of glucose homeostasis occurring as a complication of liver disease • Hepatitis • Cirrhosis • Hepatocellular carcinoma • Fulminant hepatic failure • Postorthotopic liver transplantation 3 . Liver disease occurring coincidentally Continue reading >>

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