liver kidney disease

1. STUDY OF LIVER DISEASES IN TYPE 2
DIABETES MELLITUS
Author - Nutan agarwal1 , Ashish kr Sharma2, Navnit agarwal3, N.S.Sengar4, Zaki siddiqui5,
Mandivi agarwal6
Presented by - Dr. Ashish kr sharma
Senior resident
Dept of Medicine
M.L.B.MEDICAL COLLEGE, JHANSI,U.P. 284128

2. • BACKGROUND -
• Type 2 diabetes mellitus (type 2 DM) is one of the common epidemics
worldwide.
• Liver disease is an important cause of death in type 2 diabetes.
• The entire spectrum includes abnormal liver enzymes, non alcoholic fatty
liver disease (NAFLD), hepatocellular carcinoma, and acute liver failure.

3. AIMS AND OBJECTIVES -
• To estimate the prevalence of liver function abnormalities in type 2
diabetic patients.

4. MATERIAL & METHODS -
The present study was conducted on patients attending the diabetes clinic in
dept of medicine, MLB medical college Jhansi from March 2012 to august
2013. In this study, 450 patients were enrolled. They were, divided into three
groups ( Group ‘A’, Group ‘B’, Group ‘C’) based on duration of diabetes( <5
yrs, 5-10years , >10yrs.respectively).

5. INCLUSION CRITERIA-
Diagnosed pt. of DM or/and with symptoms of diabetes plus Random
Blood Sugar >200 mg/dl or fasting blood glucose >126 mg/dl or 2 hr
Post Prandial >200 mg/dl during oral glucose tolerance test.
EXCLUSION CRITERIA –
patients diagnosed diabetics with preexisting liver disease,co morbidity
like hepatototixic drug, alcoholism etc need to be exclude.

6. • Detail history of each patient including h/o yellowish discolouration of urine
and sclera, H/0 blood transfusions, dietry history, drug history etc.
• Each patient was also inquired about the duration of symptoms.
INVESTIGATIONS -
Complete blood count, Urine R/M, Blood sugar
SPECIFIC INVESTIGATIONS –
HCV reactivity, HBsAg reactivity, Serum bilirubin, SGOT, SGPT, USG
Abdomen.

7. • RESULTS -
Out of studied 450 patients 253 (56.30%) pts were in Group ‘A’, 150 (33.40%)
pts were in Group ‘B’, and 47 (10.30%) pts were in Group ‘C’.
253
(56.30%)
150
(33.40%)
47
(10.30%)
Case distribution
<5 yr 5-10 yr >10 yr

9. LIVER ENZYMES (AST/ALT) AND SERUM BILIRUBIN –
• In our study mild elevation of liver enzymes was detected overall in 20.66%
(<2 times of ULN).
• In 7.33% patients the liver enzymes are markedly elevated (>2 times of
ULN).
• Increased serum bilirubin (>2 mg%) was present in 7.11% pts.
• As the duration of diabetes increased serum bilirubin and liver enzymes
increased.

10. Duration
of type 2
DM
Increased
liver
enzyme
AST/ALT AST/ALT>2ULN Increased
bilirubin
No. % No. % >2mg% %
<5 yr 253 39 15.4 12 4.74 11 2.44
5-10 yr 150 41 27.33 14 9.33 14 3.11
>10 yr 47 13 26.65 7 15 7 1.55
Total 450 93 20.66 33 7.33 32 7.11

11. LIVER USG ABNORMALITIES -
• Out of 450 pts 32 pts (7.11%) had abnormal liver USG and 21 pts (4.66%) had
both liver and kidney USG.
• NAFLD was most common USG abnormality present in 19 pts out of 32 pts.(
59.37%)
• Other USG abnormalities was cholecystitis+ cholelithiasis and cirrhosis of
liver present in 10 (31.05%) and 3 (9.3%) pts respectively.
• Out of 3 pts who developed cirrhosis of liver 2 were HbsAg reactive and 1 pts
was both HbsAg and HCV reactive.

12. USG findings
(n=32)
Duration of diabetes
Total
< 5 yrs (n=5)
(15.62%)
5-10 yrs
(n=12)
(37.5%)
> 10 yrs (n=15)
(46.87%)
Non Alcoholic
Fatty liver
2 (40.0%) 9(75.0%) 8 (53.33%) 19 (59.37%)
Cholecystitis +
cholelithiasis
3 (60.0%) 2 (16.16%) 5 (33.33%) 10 (31.25%)
Cirrhosis of
liver
0 (0) 1 (8.33%)
(HbsAg +ve)
2 (13.33%)
1pt=HbSAg+ve
1pt =HbSAg HCV
+ve
3 (9.3%)
X2=
3.795, df= 4, p value =0.04
P VALUE WAS 0.04 AND IS STATISTICALLY SIGNIFICANT

13. • Out of 450 pts 15 pts (3.33%) pts were HbsAg reactive and 2 pts (0.4%)
were found HCV positive.
Duration of type 2 DM Total no. of
subjects
HBsAg positive
No. %
<5 yr 253 8 3.16
5-10 yr 150 4 2.67
>10 yr 47 3 6.38
Total 450 15 3.33
HbsAg positive -

14. Duration of type 2 DM Total no. of
subjects
HCV positive
No. %
<5 yr 253 0 0
5-10 yr 150 1 0.6
>10 yr 47 1 2.12
Total 450 2 0.4
HCV positive -

15. CONCLUSION –
• In our study mild elevation of liver enzymes (<2 times of ULN) was present
in 20.66% and marked elevation (>2 times of ULN) in 7.33% patients.
• Increased serum bilirubin (>2 mg%) was prsent in 7.11% pts.
• As the duration of diabetes increased serum bilirubin and liver enzymes
increased.
• NAFLD was most common USG abnormality present in 19 pts ( 59.37%).
• Out of 450 pts 15 pts (3.33%) pts were HbsAg reactive and 2 pts (0.4%)
were found HCV positive.

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