Evolutionary peculiarities of diabetes mellitus in liver cirrhosis

Abstract

Background. Diabetes mellitus is a common comorbidity in patients with liver cirrhosis, negatively influencing the evolution and prognosis of the disease. Its evolutionary forms, especially hepatogenic diabetes, have specific mechanisms and clinical features, which require early recognition and selective treatment. Objective(s). Analysis of the evolutionary and clinico-pathogenetic characteristics of diabetes mellitus in liver cirrhosis, highlighting the differences from type 2 diabetes and the therapeutic implications. Materials and methods. A study of the scientific literature published in 2013-2024 was conducted, using PubMed, ScienceDirect, MEDLINE and Wiley data. Terms used: "hepatogenic diabetes", "liver cirrhosis", "insulin resistance". From the articles, 10 relevant studies were selected according to the criteria of topicality, clinical validity, and scientific value. Results. Diabetes in cirrhosis may be pre-existing or acquired later in the form of hepatogenic diabetes. It is characterized by hepatic insulin resistance, β-cell dysfunction, and frequently falsely low HbA1c values. The most recommended diagnostic method is the oral glucose tolerance test. Glucose metabolism disorders can reach 80%, and clinical diabetes occurs in about 30% of patients. Its evolution is associated with an increased risk of hepatic encephalopathy, infections, hemorrhages, and post-transplant mortality. Treatment requires individualized adjustments, and therapeutic options are limited by the remaining liver function. Conclusion(s). Diabetes mellitus in liver cirrhosis has a particular evolution, being often underdiagnosed and difficult to treat. Early diagnosis and personalized therapeutic approach are essential for preventing complications and reducing mortality; achieving these goals requires multidisciplinary collaboration.