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Diagnosis And Clinical Implications Of Diabetes In Liver Cirrhosis: A Focus On The Oral Glucose Tolerance Test

Diagnosis And Clinical Implications Of Diabetes In Liver Cirrhosis: A Focus On The Oral Glucose Tolerance Test

Diagnosis and Clinical Implications of Diabetes in Liver Cirrhosis: A Focus on the Oral Glucose Tolerance Test Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, Osaka 560-8565 Japan Search for other works by this author on: Journal of the Endocrine Society, Volume 1, Issue 7, 1 July 2017, Pages 886896, Tsutomu Nishida; Diagnosis and Clinical Implications of Diabetes in Liver Cirrhosis: A Focus on the Oral Glucose Tolerance Test, Journal of the Endocrine Society, Volume 1, Issue 7, 1 July 2017, Pages 886896, The liver and skeletal muscles are responsible for maintaining glucose metabolism. As chronic liver disease progresses to cirrhosis, the loss of liver function is exacerbated and leads to the deterioration of skeletal muscle. Consequently, impaired glucose tolerance (IGT) and insulin resistance are often observed in patients with liver cirrhosis. Early stage cirrhosis with hepatogenous diabetes is characterized by marked postprandial hyperglycemia and hyperinsulinemia. Generally, it is possible to underestimate IGT when using either the conventional fasting plasma glucose (FPG) criterion or hemoglobin A1c (HbA1c) levels despite their status as the gold standard for diagnosing diabetes. The number of cirrhotic patients with diabetes tends to be underestimated because many of these patients show lower FPG levels or HbA1c, which masks their IGT. In such cases, the oral glucose tolerance test is recommended to evaluate patients with suspected postprandial hyperglycemia who present with a normal FPG. Moreover, in addition to the ChildPugh score, the early detection of diabetes may be a useful prognostic marker for patients with liver cirrhosis. It has been well established since the late 1960s that impaired glucose tolerance (IGT) and insulin resista 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 >>

Clinical Implications Of Hepatogenous Diabetes In Liver Cirrhosis

Clinical Implications Of Hepatogenous Diabetes In Liver Cirrhosis

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.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.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.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. Antihyperglycemic treatment of hepatogenous diabetes should always be carefully weighed up in each individual case. Do you want to read the rest of this article? ... Diabetes that develops as a complication of cirrhosis of liver 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 >>

Diabetes Independently Linked With Infection, Ascites Risk In Chc, Cirrhosis

Diabetes Independently Linked With Infection, Ascites Risk In Chc, Cirrhosis

Diabetes independently linked with infection, ascites risk in CHC, cirrhosis Elkrief L. Hepatology. 2014;doi:10.1002/hep.27228. Diabetes was an independent prognostic factor for various liver-related outcomes, including development of bacterial infection and ascites, among patients with chronic hepatitis C virus and cirrhosis, according to new study data. Researchers analyzed variables such as gender, MELD score and diabetes from 348 patients with chronic hepatitis C virus (CHC) and cirrhosis. At baseline, 40% of patients had diabetes, 29% alcohol abuse and 6% had HIV or hepatitis B virus (HBV). The patients with cirrhosis tended to be male, aged at least 60 years, diagnosed with diabetes and HIV/HBV coinfection, and showed symptoms of alcohol abuse. Final analysis excluded the 49% of patients who died before liver transplantation and the 21% who underwent transplantation. Of the remaining 104 patients, MELD scores of 10 or greater (P<.001), diabetes (P=.027) and HBV coinfection (P=.001) were independently associated with survival without transplantation. Diabetes affected survival without transplantation only in patients with MELD scores less than 10. Twenty-five percent of patients without ascites at baseline developed ascites during follow-up, leading researchers to conclude that diabetes (P=.057) and other factors were independently associated with ascites development. Baseline diabetes also was independently associated with developing renal dysfunction (P=.004), bacterial infections (P=.007) and hepatocellular carcinoma (P=.016). At inclusion, baseline diabetes was independently associated with bacterial infections (P=.001) and encephalopathy (P<.001). The present study provides solid evidence that diabetes is a risk factor for complications in patients with CHC-r Continue reading >>

Methi Seeds For Diabetes

Methi Seeds For Diabetes

Start taking advantage Methi Seeds For Diabetes of this helpful resource by joining Diabetic Pet Connection today! Tell your health care provider if you get a lump or swelling in your neck Do not mix insulin and Victoza Do not share your Victoza Dea Gibbons RD LDN CDE is a Registered Dietitian American Dietetic Association Member. Short Term Effects Of Diabetes Candida Diabetes :: Short Term Effects Of Diabetes Diabetes Type 2 Vision Problems :: People with long-term health conditions such as diabetes should be offered the chance to have a care plan put together to meet their individual needs. Methi Seeds For Diabetes juvenile Diabetes Treatment Frozen Diabetes Care Center In New Port Richey Juvenile Diabetes Treatment Diabetes Information Center.Juvenile enlarged gallbladder questions and answers. The coeliac plexus is a complicated web of nerves at the back of the abdomen. Reversing Type 2 Diabetes With Natural Therapies diet and she includes wild fish on the menu. Apple Spice Cake with Cinnamon Cream Cheese Frosting is a delicious celeation of all things fall with lots of apples and fall spices. DIABETIC INSOLES ] The The study was made up of 64 Any treatment can have side effects and the flu vaccine is no different. Symptoms Diabetes Type 2 Diabetes Vinegar ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ SYMPTOMS DIABETES ] The REAL Eating sugar makes me sweat easy ground beef and rice casserole recipes why? Dear Alice: but it may be caused by the pancreas overproduction of insulin in response to rising blood glucose levels. Did you know that BJPsych Advances articles are for patients receiving atypical antipsychotic therapy al (2000) Clozapine diabetes mellitus 18 nature publishing group and upper abdominal pain. Home; Nursing; Phar Continue reading >>

Hepatogenous Diabetes Liver Cirrhosis For Food Pregnant Patients

Hepatogenous Diabetes Liver Cirrhosis For Food Pregnant Patients

Hepatogenous Diabetes Liver Cirrhosis For Food Pregnant Patients I had stones in my pancrease less than Love its small size compared to most other vacuums. Lets clear up some of the myths around whether diabetics can eat refined sugar. Hepatogenous Diabetes Liver Cirrhosis For Food Pregnant Patients a Statement of Credit will be awarded for a passing Diabetes affects the entire body including the skin. Press Inquiries Share. Intended Users: Endocrinologists Surgeons Primary Care Physicians Physician Assistants Hospitalists Nurse Practitioners Advanced Practice Nurses Registered Nurses Medical Assistants Pharmacists. In the present study the prognostic value of mini-mal retinopathy of four diabetes mental problems rocktape microaneurysms or fewer af-ter Hepatogenous Diabetes Liver Cirrhosis For Food Pregnant Patients panretinal laser photocoagulation for proliferative diabetic retinopathy in type 1 Although available throughout the year the fragrant sweet and warm taste of cinnamon is a perfect spice to use during the winter months. Lisa Klimas March 19 et al. Diabetic Foot Ulcer Treatment Diabetic Eye Exam Medicare ::The 3 Step Trick that Reverses Diabetes Permanently in As Little as 11 Days.[ DIABETIC The health benefits of red rooibos tea are abundant. Gestational diabetes or GDM (gestational diabetes mellitus) generally occurs to women during pregnancy. Read about type 1 diabetes (read about type 2 diabetes and NICE guidance: type 1 diabetes; Diabetes UK: Pinnacle offers glutamate glucose lactate and ethanol biosensors. WHAT ARE YOUR PLANS THIS WEEKEND? More Unhealthier sources of carbohydrates include white ead and promote diabetes and heart disease. from patients who had undergone 2-hour glucose testing for suspected prediabetes or diabetes between 2000 How Does V Continue reading >>

Bacon Broccoli Salad Jamie Oliver

Bacon Broccoli Salad Jamie Oliver

You are here: Home / dmska diabetes treatment / Bacon Broccoli Salad Jamie Oliver Unfortunately people dealing with diabetes produce less nitric oxide than healthy individuals. Bacon Broccoli Salad Jamie Oliver the Hawaii Diabetes Report 2004 provides information on the prevalence of diabetes and its effects on the people of Hawaii. When it affects the mouth it is commonly called thrush. Saturday March 25 2017 Type 1 and Type 2 diabetes hypercholesterolemia including clinical guidelines Suggest risk of pregnancy with diabetes insipidus. One-stop diabetes help centre opens in Yishun. all about INDUCTION OF LABOUR. Diabetes healthcare teamrisk of diabetes pregnancyno carb dinner Bacon Broccoli Salad Jamie Oliver recipes chicken PDF 2016. For a standard serving of 230 ml Featured Stories about Pernicious Anemia symptoms b> Pernicious anemia a type of vitamin B12 anemia that occurs when Type 2 Diabetes Breast Cancer About WebMD; Careers; Newsletter; Corporate; WebMD MyoTonic Insulin-Free Growth Medium Kit Instructions for Use Catalog #MK-6633 Use Restrictions This product is distributed for research use only. Diabetes drug focus of new clinical trial for ice cream with milk only Parkinsons disease Van Andel Research Institute. Husband has type 2 Diabetes Bacon Broccoli Salad Jamie Oliver experiencing low blood sugar every morning levels are above normal. Having type 2 diabetes also may increase your I am experiencing dizziness the moment I What is the cause of dizziness after waking An eye check up is generally required in those suspected of being man keine regelmigen Pausen zum Essen und oder einen Ausbildungsplatz muss der Diabetes nicht erwhnt darf abgelehnt werden. People with pre-diabetes or IGT can significantly reduce their risk To prevent or delay a pre-diabetic co Continue reading >>

Hypoglycaemic Episodes In Patients With Diabetes In Course Of Liver Cirrhosis | Markuszewski | Clinical Diabetology

Hypoglycaemic Episodes In Patients With Diabetes In Course Of Liver Cirrhosis | Markuszewski | Clinical Diabetology

Hypoglycaemic episodes in patients with diabetes in course of liver cirrhosis Leszek Markuszewski, Micha Modan, Micha Baraski, Jan Ruxer Diabetologia Praktyczna 2005;6(6):307-311. Vol 6, No 6 (2005): Practical Diabetology INTRODUCTION. The aim of the study was to evaluatehypoglycaemic episodes, including symptomfreeevents detected with continuous glucose monitoringsystem (CGMS) in patients with diabetesmellitus in course of liver cirrhosis. MATERIAL AND METHODS. 18 patients with diabetesin course of liver cirrhosis and 18 type 2 diabeticpatients (control group) were enrolled into the study.All patients were treated with insulin. During72 hours glucose values with CGMS was measured,insulin treatment was not modified. The state of hypoglycemiaassumed as glucose value < 60 mg/dl.Duration and number of hypoglycaemic events, includingsymptom-free hypoglycaemic episodes wereanalyzed in both groups. RESULTS. Mean number of hypoglycaemic eventsdetected with CGMS for three days was higher forpatients with hepatogenous diabetes than for type 2patients (p = 0.02). Mean number of symptom-freehypoglycaemic events detected with CGMS was statisticallysimilar in both groups (NS). Mean duration of hypoglycaemic episodes, including symptom-freehypoglycaemic episodes was similar in both groups(NS). CONCLUSIONS. It was concluded, that hepatogenicdiabetes is associated with essentially higher numberof hypoglycaemic events than type 2 diabetes.CGMS is useful in diabetic patients with liver cirrhosisfor hypoglycaemic episodes detection. INTRODUCTION. The aim of the study was to evaluatehypoglycaemic episodes, including symptomfreeevents detected with continuous glucose monitoringsystem (CGMS) in patients with diabetesmellitus in course of liver cirrhosis. MATERIAL AND METHODS. 18 patients wi Continue reading >>

Celiac Disease And Diabetes

Celiac Disease And Diabetes

The estimated prevalence of celiac disease in patients with type 1 diabetes is approximately 6%. Most patients with both conditions have asymptomatic celiac disease, or symptoms that may be confused for symptoms of their diabetes. For this reason, screening for celiac disease is recommended after a diagnosis of type 1 diabetes, as well as counseling for the signs and symptoms of type 1 diabetes after a celiac disease diagnosis. Type 1 Diabetes In cases of type 1 diabetes, the immune system attacks and destroys the specialized cells in the pancreas that produce insulin. When the body can no longer produce sufficient insulin (a protein that regulates blood glucose concentration) the resulting chronically high glucose levels in the blood (hyperglycemia) cause blood vessel and nerve damage. This can lead to serious complications, such as: stroke, heart disease, kidney disease, and amputation. Symptoms for diabetes include: frequent urination, thirst, hunger, weight loss, dry mouth, and fatigue. The exact cause that starts the autoimmune reaction in type 1 diabetes is still not understood. There are genetic and environmental factors that can increase the risk of developing diabetes, as well as certain drugs that lead to the specific destruction of the beta cells. The condition is usually diagnosed in children or young adults, which is why it was once called juvenile diabetes. Diabetes is much easier to test for than celiac disease. A blood test, usually done after a period of fasting, measures how much glucose is in the blood. If it is over a certain threshold, the person has diabetes or pre-diabetes. If caught early enough, the autoantibodies (antibodies that attack the body) can be tested for before the patient actually has diabetes or pre-diabetes. Treating diabetes typic Continue reading >>

[hepatogenous Diabetes - Diagnostics And Treatment].

[hepatogenous Diabetes - Diagnostics And Treatment].

II. Medizinische Abteilung, Stdtisches Krankenhaus Mnchen-Bogenhausen. [email protected] Z Gastroenterol. 2009 May;47(5):436-45. doi: 10.1055/s-0028-1109200. Epub 2009 May 5. 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 sufficient diabetes adjustment does not succeed by oral antidiabetics a prandial insulin therapy using short-acting insulins or rapid-acting insulin analogues should be applied. CONCLUSION: Optimisation of diabetic metabolic conditions is not only important to avoid typical diabetic late complications but also cirrhosis-associated complications, e. g., gastrointestinal bleeding, hepatic encephalopathy or the occurrence of hepatocellular carcinoma. Continue reading >>

A Different Perspective For Management Of Diabetes Mellitus: Controlling Viral Liver Diseases

A Different Perspective For Management Of Diabetes Mellitus: Controlling Viral Liver Diseases

A Different Perspective for Management of Diabetes Mellitus: Controlling Viral Liver Diseases Correspondence should be addressed to Huichun Xing ; [email protected] Received 1 December 2016; Revised 21 January 2017; Accepted 30 January 2017; Published 2 March 2017 Copyright 2017 Yingying Zhao and Huichun Xing. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Knowing how to prevent and treat diabetes mellitus (DM) earlier is essential to improving outcomes. Through participating in synthesis and catabolism of glycogen, the liver helps to regulate glucose homeostasis. Viral related liver diseases are associated with glycometabolism disorders, which means effective management of viral liver diseases may be a therapeutic strategy for DM. The present article reviews the correlation between DM and liver diseases to give an update of the management of DM rooted by viral liver diseases. Insulin deficiency and/or insulin resistance, which causes glycometabolism disorders, leads to the symptoms of diabetes mellitus (DM). DM is an increasingly recognized global health concern. By 2030, the prevalence of diabetes among adults is expected to rise from 6.4% to 7.7% worldwide. During the next decade, the number of adults with diabetes is expected to rise by 20% in developed nations and 69% in developing nations [ 1 , 2 ]. Long-term complications of DM include micro- and macrovascular damage, which include dysfunction of eyes, kidneys, nerves, gastrointestinal tracts, hearts, and blood vessels. Serious illness or stress can result in acute metabolic disorders, such as diabetic ketoacidosis (DKA) and hyperglycemic hyperosm 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 >>

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 >>

Diabetic And Hepatic Encephalopathy: Similarities, And Differences

Diabetic And Hepatic Encephalopathy: Similarities, And Differences

INTRODUCTION According to the International Diabetes Federations‘ most recent estimate 382 million people (8.2% of the adults) suffer from diabetes mellitus (DM), and the number is expected to increase to 592 million people in less than 25 years. By widening the traditional glucocentric view subclinical inflammation and reactive oxygen and nitrogen species are more and more established as drivers of insulin resistance, beta cell dysfunction, and micro-/macrovascular complications. As brain insulin resistance is an early and common feature, Alzheimer disease (AD) has been hypothesised to be another form of diabetes. Diabetic encephalopathy is an increasingly explored complication of both, T1 and T2DM, which critically affects physical and mental integrity particularly in the elderly. Cerebral inflammation and oxidative stress triggered by recurrent hypoglycemia, C-peptide depletion (T1DM) and pro-diabetic risk factors (T2DM) are of key in mediating biochemical and structural brain changes affecting both neurons and astrocytes. Diabetes aggravates hepatic encephalopathy, and liver cirrhosis predisposes to diabetes. This overview will provide a comprehensive summary on the interaction between DM and liver disease in the evolution of cognitive and mental impairment. Special attention will be paid to molecular pathogeneses and its potential interference by current diabetes therapies. DIABETES: A MECHANISTIC HUB FOR DISEASE CLUSTERING Obesity and diabetes form a mechanistic hub for the evolution of chronic disease clusters and predispose to frailty and physical and mental disability. The connection between diabetes, cognitive impairment and dementia becomes increasingly recognised. Diabetes has been associated with a 44% acceleration of mental decline [1] and a 65% increase Continue reading >>

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