Incidence and Factors Associated with Undiagnosed Diabetes by Fasting Plasma Glucose in Cirrhotic Patients
Shinrattanaroj P, MD1, Pornthisarn B, MD1, Vilaichone R, MD, PhD1,3, Chonprasertsuk S, MD MSc1, Kanokwanvimol A, MD1, Bhanthumkomol P, MD1, Chotivitayatarakorn P, MD1, Anthanont P, MD2, Siramolpiwat S, MD, MSc1,3
Affiliation : 1 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 2 Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathumthani, Thailand 3 Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
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).
Objective : The aim of this study is to determine the incidence and factors associated with undiagnosed diabetes by FPG in cirrhotic
patients.
Materials 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 to 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 <100 x103/uL, presence of large varices or ascites were associated with
undiagnosed diabetes. However, by multivariate analysis, only age, and platelet count <100 x103/uL were independently associated
with undiagnosed diabetes with odds ratio of 1.11, and 6.4, respectively.
Conclusion : Undiagnosed diabetes by FPG is prevalent in patients with cirrhosis, and is associated with disease severity. Therefore,
OGTT may be considered despite having a normal FPG, especially in patients with advanced liver disease.
Keywords : Cirrhosis, Diabetes, Fasting plasma glucose, Glucose tolerance test
