Published online Mar 14, 2016. doi: 10.3748/wjg.v22.i10.2869
Peer-review started: December 24, 2015
First decision: January 13, 2016
Revised: January 20, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: March 14, 2016
Diabetes mellitus (DM) that occurs because of chronic liver disease (CLD) is known as hepatogenous diabetes (HD). Although the association of diabetes and liver cirrhosis was described forty years ago, it was scarcely studied for long time. Patients suffering from this condition have low frequency of risk factors of type 2 DM. Its incidence is higher in CLD of viral, alcoholic and cryptogenic etiology. Its pathophysiology relates to liver damage, pancreatic dysfunction, interactions between hepatitis C virus (HCV) and glucose metabolism mechanisms and genetic susceptibility. It associates with increased rate of liver complications and hepatocellular carcinoma, and decreased 5-year survival rate. It reduces sustained virological response in HCV infected patients. In spite of these evidences, the American Diabetes Association does not recognize HD. In addition, the impact of glucose control on clinical outcomes of patients has not been evaluated. Treatment of diabetes may be difficult due to liver insufficiency and hepatotoxicity of antidiabetic drugs. Notwithstanding, no therapeutic guidelines have been implemented up to date. In this editorial, authors discuss the reasons why they think that HD may be a neglected pathological condition and call attention to the necessity for more clinical research on different fields of this disease.
Core tip: The authors expose arguments, which indicate that hepatogenous diabetes has not received enough attention for many years. They provide published evidences that make them to propose that this entity should be considered as a complication of chronic liver disease, and that an oral glucose tolerance test must be done to patients without previous diabetes mellitus showing normal fasting plasma glucose levels. They also propose that an adequate treatment of hyperglycemia with liver friendly-drugs must be undertaken for reducing complications and mortality. They also highlight the lack of research on long-term treatment of diabetes and the lack of treatment recommendations for these vulnerable patients.