Concepts of management of diabetes in chronic liver
1. {
Concepts of management of
diabetes in Chronic liver disease
By Ahmed Elmoughazy
Internal medicine resident, Medical research institute, Alexandria
university
2. 70%
30%
Prevalence of Diabetes among CLD
No Diabetes
Diabetes
Garcia-Compean D, Jaquez-Quintana JO, Gonzalez-Gonzalez JA, Maldonado-Garza H. Liver cirrhosis and diabetes: risk factors, pathophysiology, clinical
implications and management. World J Gastroenterol. 2009 Jan 21;15(3):280–8.
3. Patients with chronic liver disease have a high
prevalence of glucose intolerance and diabetes
because of the presence of
1. insulin resistance
2. β-cell dysfunction.
7. If a patient has stable CLD and few other comorbidities,
metformin is likely to be reasonably safe, but the dose
should be decreased to a maximum of 1500 mg daily.
The drug should be withdrawn if liver or renal function is
deteriorating, or in the setting of acute illness or
decompensation.
Metformin
8. Sulfonylureas and
meglitinides
Because they are metabolized by the liver, their duration of
action may be prolonged in patients with CLD. Therefore:
1. They should be avoided or used with caution at low doses
in patients with T2DM and CLD.
2. Short acting glipizideis preferred.
9. It may have a specific role in patients with CLD and diabetes,
particularly in patients with NAFLD and NASH, as a
randomized study showed improvement in histological indices
in patients with NASH who were treated with pioglitazone.
Careful liver function test monitoring is indicated in all patients
commencing pioglitazone therapy.
Thiazolidinediones
10. Sitagliptin & saxagliptin can be safely
used without dose adjustment.
Vildagliptin is not approved in patients
with hepatic insufficiency.
DPP4-inhibitors
11. Insulin therapy is the safest and most effective
antihyperglycemic therapy in patients with
CLD.
It is the onlyapproved and safe wayto control diabetes in
Decompensated Chronic liverdisease.
Dose may be decreased due to reduced hepatic
breakdown of insulin.
Insulin
13. In compensated CLD, Oral hypoglycmic drugs
are legit to use with special precautions.
Insulin remains the safest and the most
effective way to control diabetes in CLD
patients in general , and the only way to
manage DM in Decompensated liver disease
specifically.
