Liver Diseases and Glucose Metabolism

Liver diseases are associated with insulin resistance; liver cirrhosis is often accompanied by glucose intolerance and hepatic diabetes mellitus - which resembles type 2 diabetes. The prevalence and severity of alterations in glucose metabolism depend on the severity of the liver disease, on comorbidity (e.g. obesity), and on the aetiology of the liver disease. Type 2 diabetes is associated with more rapid progression of liver disease towards cirrhosis and hepatocellular carcinoma. The hepatitis C virus (HCV) causes alterations in the metabolism of glucose and insulin which are not explained by the severity of the liver disease; these alterations also depend on the HCV genotype. Insulin resistance and type 2 diabetes are more prevalent in hepatitis C than in non-infected controls or patients with hepatitis B. Diabetes in hepatitis C accelerates the progression of fibrosis and decreases the chance of successful antiviral therapy. The early forms of haemochromatosis are associated with reversible insulin resistance. In severe haemochromatosis, iron excess in B cells causes irreversible insulin-dependent diabetes mellitus.