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Advanced liver disease and insulin resistance- is there a connection?

Introduction: Glycemic alterations are a hallmark of liver cirrhosis due to both beta-cell dysfunction and impaired insulin sensitivity. Loss of liver function seems to play an important role in development of glucose intolerance and diabetes, as liver transplantation usually ameliorates aforementioned disturbances. The prevalence of insulin resistance (IR) and its relation to the stage of liver disease in euglycemic patients, was investigated in this study. Methods: One hundred and eighty-three euglycemic patients with cirrhosis of varying etiology were included. Cirrhosis was proven either histologically or clinically. Patients were classified into Child-Pugh class A, B or C, and MELD/MELD-Na score was calculated. IR was assessed by the Homeostasis Model Assessment (HOMA) model. The cut off value of 1, 64 was used in this study. Results: Results: Overall, IR was observed in 77, 8% of euglycemic cirrhosis. IR and non-IR patients were not equally distributed among MELD/MELD-Na classes (p=0, 0054 ; p=0, 0057, 2 - test), with IR more frequently observed in MELD/MELD-Na ≥ 10. However, no significant difference was found between IR occurrence and CP classes. The findings were not supported by further analysis, as Pearson correlation coefficients between HOMA-IR and CP/MELD/MELD-Na scores, as well as mean HOMA-IR values among different CP/MELD/MELD-Na classes (ANOVA test) were found to be non-significant. Conclusion: IR is common in euglycemic cirrhosis and with advancement of liver disease, however no correlation between liver disease stage and IR was found in our study sample. A possible explanation is that loss of liver function affects primarily beta-cell function, which exerts a more important role than IR on the development of ‘hepatogenous diabetes’.

LIVER CIRRHOSIS, INSULIN RESISTANCE

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