ديابت و اختلال تحمل گلوكز در بيماران مبتلا به بيماري مزمن كبدي

Background: Alterations in carbohydrate metabolism are frequently observed in cirrhosis. We conducted this study to define the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in patients with chronic liver disease (CLD), and explore the factors that may be potentially associated with the development of DM in these patients. Methods: From October 2002 to March 2003, 185 consecutive patients with CLD, who referred to "Tehran Hepatitis Center", were enrolled into the study. Fasting plasma glucose and two-hour plasma glucose were measured in patientsʹ sera. DM and IGT were diagnosed according to latest American Diabetes Association criteria. Results: The subjects included 42 inactive HBV carriers, 102 patients with HBV or HCV chronic hepatitis, and 41 cirrhotic patients. Mean age was 43.8^12.0 years ranging between 22 to 84 years. DM and IGT were diagnosed in 40 (21.6%) and 21 (11.4%) patients, respectively. Univariate analysis showed that age (P=0.000), CLD status (P=0.000), history of hypertension (P=0.007), family history of DM (P=0.000), and body mass index (BMI) (P==0.009) were associated with DM. Using Multivariate analysis, age (P=0.01), family history of DM (P=0.0001), chronic hepatitis (0.0004), and cirrhosis (P=0.0004) remained as the factoi"s independently associated with DM. When patients with cirrhosis and chronic hepatitis were analyzed separately, higher Child-Pughʹs score in cirrhosis (P=0.04) and older age (P=0.04), higher fibrosis score (P=0.04), and higher BMI (P=0.003) in patients with chronic hepatitis were found to be associated with higher prevalence of DM. Conclusion: Our findings indicated that patients with cirrhosis and chronic hepatitis are at risk of developing DM. Older age, sever liver disease, and obesity were associated with development of DM.