Prevalence of insulin resistance among patients with cirrhosis of liver
Author(s): Dr. Mohammed Ismail KK and Dr. Riyas C
Abstract:Introduction: Liver cirrhosis is an unique clinical entity in which long-term diabetes mellitus (DM) can predispose individuals to cirrhosis and, on the other hand, long-term cirrhosis of the liver can predispose cirrhosis to DM, secondary to glucose and insulin metabolism.
Aims: The aim of this study is to determine the prevalence of insulin resistance in liver cirrhosis.
Materials and Methods: This cross sectional case control study conducted in department of medicine in 80 patients for duration of 1 year. All cirrhotic patients irrespective of aetiology were subjected to fasting plasma glucose level and fasting plasma insulin levels and insulin resistance was calculated by HOMA-IR method. Study was statistically analysed.
Results: Insulin resistance was found in 62 cases with IR in ratio in <1.64 is 0.81+0.5 and IR ratio >1.64 is 4.6+2.9. with p value is <0.001 which is highly significant. Insulin Resistance among alcoholic, NAFLD, Autoimmune hepatitis and HCC patients was found significant when compared to non-insulin resistant patients. Prevalence of Insulin resistance increased with increasing grades of child Pugh score. As Insulin Resistance was detected in 62 out of 80 patients who even had HbA1c levels below 5.7 and in 28 out of 62 had FPG levels below 100.
Conclusion: Insulin resistance may be used as a valuable prognosis marker in patients with cirrhosis of the liver, serum insulin levels can be prescribed as routine tests in these patients. Diabetes mellitus raises the risk of HCC in patients with cirrhosis. Thus, through early detection of diabetes mellitus, by measuring insulin resistance using the HOMA-IR process, we can prevent disease progression.