Concepts of management of diabetes in chronic liver

Concepts of Treating diabetes in chronic liver disease and different stages of cirrhosis

1. Concepts of management of diabetes in Chronic liver disease By Ahmed Elmoughazy Internal medicine resident, Medical research institute, Alexandria university

2. 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 insulin resistance β-cell dysfunction.

4. How to Monitor?

5. How to control ?

6. 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. T he drug should be withdrawn if liver or renal function is deteriorating, or in the setting of acute illness or decompensation . Met f ormin

7. Sulfonylureas and meglitinides Because they are metabolized by the liver, their duration of action may be prolonged in patients with CLD. Therefore: They should be avoided or used with caution at low doses in patients with T2DM and CLD. Short acting glipizide is preferred.

8. 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

9. Sitagliptin & saxagliptin can be safely used without dose adjustment. Vildagliptin is not approved in patients with hepatic insufficiency. DPP4-inhibitors

10. Insulin therapy is the safest and most effective antihyperglycemic therapy in patients with CLD. It is the only approved and safe way to control diabetes in Decompensated Chronic liver disease . Dose may be decreased due to reduced hepatic breakdown of insulin. Insulin

11. Conclusion

12. 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.