Background: Abnormal glucose homeostasis, including diabetes mellitus, is common in patients with liver cirrhosis. However, diabetes in these patients is frequently underdiagnosed by fasting plasma glucose (FPG). The aim of this study is to determine the incidence and factors associated with undiagnosed diabetes by FPG in cirrhotic patients.

Material and Methods: Cirrhotic patients without known history diabetes who had normal FPG (<126 mg/dL) were enrolled in this study. A 75-gm oral glucose tolerance test (OGTT) was performed in all patients. Normal glucose tolerance (NGT) was defined as 2-h plasma glucose (PG) <140 mg/dL, impaired glucose tolerance (IGT) as 2-h PG between 140-199 mg/dL, and undiagnosed diabetes as 2-h PG 200 mg/dL. Demographic parameters were compared between groups, and uni- and multivariate logistic regression analysis was performed to identify factors associated with undiagnosed diabetes. 

Results: A total of 84 cirrhotic patients were enrolled, 59.5% were male with a mean age of 60.1 years. The common etiologies of cirrhosis were alcohol, chronic hepatitis B and C virus infection. According to the 75-g OGTT results, 52.4%, 31.1% and 15.5% were classified as NGT, IGT, and diabetes, respectively. Compared between diabetic and non-diabetic, patients with diabetes had significantly higher BMI, more proportion of large varices or ascites, lower platelets, higher INR, and lower serum albumin level. By univariate regression analysis, age, platelet count<100x10³/uL, presence of large varices or ascites were associated with undiagnosed diabetes. However, by multivariate analysis, only age, and platelet count<100x10³/uL were independently associated with undiagnosed diabetes with odds ratio of 1.11, and 6.4, respectively.