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Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2022; 28(8): 775-793
Published online Feb 28, 2022. doi: 10.3748/wjg.v28.i8.775
Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives
Diego García-Compeán, Emanuela Orsi, Ramesh Kumar, Felix Gundling, Tsutomu Nishida, Jesús Zacarías Villarreal-Pérez, Ángel N Del Cueto-Aguilera, José A González-González, Giuseppe Pugliese
Diego García-Compeán, Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
Emanuela Orsi, Diabetes Service, Endocrinology and Metabolic Diseases Unit, Fdn IRCCS Ca Granda, Endocrine Unit, Padigl Granelli, Milan 20121, Italy
Ramesh Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Felix Gundling, Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Diabetics, Metabolism and Infectious Diseases, Sozialstiftung Bamberg, Bamberg 96049, Germany
Tsutomu Nishida, Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
Jesús Zacarías Villarreal-Pérez, Department of Endocrinology, University Hospital, Autonomous University of Nuevo León, Monterrey 64700, Mexico
Ángel N Del Cueto-Aguilera, Department of Gastroenterology and Internal Medicine, Faculty of Medicine, University Hospital, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
José A González-González, Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. José E González and Medical School, Monterrey 64460, Nuevo León, Mexico
Giuseppe Pugliese, Department of Clinical and Molecular Medicine, La Sapienza University, Roma 00161, Italy
Author contributions: García-Compeán D, Orsi E, Kumar R, Gundling F and Nishida T made a bibliographic research and wrote sections of the manuscript, reviewed and corrected the final text; Cueto-Aguilera ÁN made a bibliographic research; Villarreal-Pérez JZ, González-González JA and Pugliese G critically reviewed the manuscript; García-Compeán D conceived and coordinated the whole project.
Conflict-of-interest statement: Pugliese G reported lecture fees from Novo Nordisk, Astra-Zeneca, Eli-Lilly. The other authors have no conflict to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Diego García-Compeán, MD, MSc, Professor, Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey 64700, Nuevo León, Mexico. digarciacompean@prodigy.net.mx
Received: October 10, 2021
Peer-review started: October 10, 2021
First decision: November 15, 2021
Revised: November 19, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: February 28, 2022
Abstract

Diabetes mellitus (DM) is common in liver cirrhosis (LC). The pathophysiological association is bidirectional. DM is a risk factor of LC and LC is a diabetogenic condition. In the recent years, research on different aspects of the association DM and LC has been intensified. Nevertheless, it has been insufficient and still exist many gaps. The aims of this review are: (1) To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis; (2) To evaluate the impact of DM on outcomes of LC patients; and (3) To select the most adequate management benefiting the two conditions. Literature searches were conducted using PubMed, Ovid and Scopus engines for DM and LC, diagnosis, outcomes and management. The authors also provided insight from their own published experience. Based on the published studies, two types of DM associated with LC have emerged: Type 2 DM (T2DM) and hepatogenous diabetes (HD). High-quality evidences have determined that T2DM or HD significantly increase complications and death pre and post-liver transplantation. HD has been poorly studied and has not been recognized as a complication of LC. The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure. In conclusion, the clinical impact of DM in outcomes of LC patients has been the most studied item recently. Nevertheless many gaps still exist particularly in the management. These most important gaps were highlighted in order to propose future lines for research.

Keywords: Diabetes mellitus, Liver cirrhosis, Hepatogenous diabetes, Clinical implications, Therapy

Core Tip: The prevalence of diabetes mellitus (DM) and impaired glucose tolerance in patients with liver cirrhosis (LC) is around 30% and 40% respectively. DM is a risk factor for LC and LC is a diabetogenic condition. Two types of diabetes associated with LC have emerged: Type 2 DM and hepatogenous diabetes (HD). However HD has not been recognized as a complication of LC. It is widely accepted that DM increases complications and mortality in cirrhotic patients. DM treatment is quite difficult due to liver failure. In the present review we will discuss the most recent information published in this field, pointing out the gaps that still exist in the subject.