Cirrhosis and diabetes

The frequency of diabetes, defined as persistent fasting hyperglycemia, was evaluated in a consecutive group of 240 cirrhotic patients. A randomly selected group of 411 noncirrhotic patients of similar age, admitted to the hospital during the same period, served as a control group. Diabetes was significantly more common in the cirrhotic group (40 of 240, 16.7%) than in the noncirrhotic group (29 of 411, 7.1%). In the majority, cirrhosis was apparent before the diabetes was detected; in 18% the diabetes was noted first. The diabetes in the cirrhotic group was maturity-onset in type, characterized by fasting hyperglycemia, minimal glycosuria, relative freedom from vascular complications, and simple management with diet or oral agents. Although the features of cirrhosis were similar in the groups with and without diabetes, a history of diabetes in the immediate family (46 vs 16%) and the presence of portacaval anastomoses (30 vs 13%) were far more common in those with diabetes. There are many potential diabetogenic factors operative in cirrhosis which may induce diabetes. The appropriate disorders could result in diabetes of hepatogenous, pancreatitic, hemosiderotic, kaliopenic, portal-systemic anastomotic, insulin-resistant, somatotropic, or genetic origin. The data suggest that these factors, acting individually or perhaps in various combinations, may precipitate diabetes in genetically susceptible patients or may even induce diabetes de novo in some cirrhotic patients.