Hepatogenous Diabetes in Liver Cirrhosis

Background: Disturbances of glucose metabolism, eg glucose intolerance or hepatogenous diabetes, occur frequently in patients with liver cirrhosis. They are caused by loss of hepatocellular function and insulin resistance due to chronic liver disease. Discussion: Until now there are no recommendations or guidelines regarding diagnosis and treatment of hepatogenic diabetes. Basic treatment should guarantee sufficient daily energy and protein intakes since the majority of patients with liver cirrhosis are malnourished. The risk of hypoglycaemia must be carefully considered when treating hepatogenic diabetes. Suitable oral antidiabetics are glinides, DPP4-inhibitors, and GLP1 analogues. However, there are no data from clinical studies so far. If sufficient control of diabetes cannot be achieved by oral antidiabetics prandial insulin therapy using short-acting insulins or rapid-acting insulin analogues should be applied. Conclusion: Optimisation of metabolic control is not only important to avoid typical late diabetic but also cirrhosis-associated complications, eg, gastrointestinal bleeding, hepatic encephalopathy, or the occurrence of hepatocellular carcinoma.