Comparative Study Between Hepatogenic Diabetes And Hepatic Cirrhosis With Diabetes Mellitus

Hepatogenic diabetes is a kind of metabolic disorders happened in terminal hepatic disease. It has not only hepatopathy features such as hypohepatia, portal hypertension and so on; but also complicate diabetes features, just as hyperglycemia, hyperinsulinemia and insuline-resist. Nevertheless,hepatogenic diabetes are likely to be short of the characteristics of typical diabetes mellitus features, the symptoms of hepatogenic diabetes are often overshadowed by chronic hepatopathy symptoms. Another part of clinical patients, who was diagnosed as diabetes mellitus before liver disease are easy to confuse with hepatogenic diabetes. To analyse the clinical features between Hepatogenic diabetes and primary diabetes mellitus can identify the difference, so it can guide clinical treatment.Objective: To discuss the difference of fasting plasma glucose,2 hour post challenge plasma glucose and the dose of insulin among hepatogenic diabetes caused by hepatic cirrhosis (abbreviation: hepatogenic diabetes),primary diabetes mellitus and pure diabetes mellitus. Comparative study the differences of hepatogenic diabetes, primary diabetes mellitus, pure hepatic cirrhosis among age, gender, and various biochemical markers of liver and complications.Methods: This study analyzed clinical data retrospectively from January 1998 to March 2008 in the first hospital affiliated Jilin University among fifty patients with hepatogenic diabetes, fifty patients with primary diabetes mellitus, fifty patients with pure hepatic cirrhosis and thirty patients with pure diabetes mellitus. Statistic analysis:experimental data were denoted by average±standard deviation ( x±s), variation of paring data among groups used Chi-aquare (χ2)test, p<0.05 showed that variation was significant. All of the data were analyzed by SAS9.0 software.Result: the fasting blood glucose level of hepatogenic diabetes group was slightly lower than that of pure diabetes mellitus group, but there was no significant statistically difference, compared with the primary diabetes mellitus group showed significantly lower, P<0.01. comparison among the three groups of 2 hours postprandial plasma glucose showed statistical significance, P<0.01. Daily insulin dosage of hepatogenic diabetes group was significantly lower than that of primary diabetes mellitus group and pure diabetes mellitus group, and showed statistical significance. P<0.01. However, the daily insulin dosage of primary diabetes mellitus group higher than that of pure diabetes mellitus group, but without statistically significance. The comparison of biochemical indicators among hepatogenic diabetes group, primary diabetes mellitus group and pure hepatic cirrhosis group, such as Alanine amino-transferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) andγ-glutamyl aroylamino- transferase (GGT), albumin (ALB), total bile Red-(TBIL), total bile acid (TBA), cholinesterase (CHE) by two- two compared showed no statistically significance, P>0.05. Comparison of complications rate among hepatogenic diabetes group, primary diabetes mellitus group and pure hepatic cirrhosis group: there was no significant difference in spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), gastrointestinal bleeding (UGIH) between hepatogenic diabetes group and primary diabetes mellitus group,but there were statistically significant differences between the previous group and pure hepatic cirrhosis group, P<0.01; hepatorenal syndrome (HRS) and hepatocellular carcinoma (HCC) in three groups showed no statistical significance. The albumin and FPG in both group of HD and primary diabetes mellitus group have linear negative correlation.Conclusion: 1. Hepatogenic diabetes group, and primary diabetes mellitus group have no differences in age of onset, but liver cirrhosis happened before 50-year-old was more than previous two groups. 2. Liver cirrhosis caused by hepatitis C virus or alcoholic cirrhosis is easier for the development of HD than liver cirrhosis caused by hepatitis B virus. 3. All of FPG, 2hPG and daily insulin dosage of primary diabetes mellitus were higher than that of hepatogenic diabetes group and pure hepatic cirrhosis group. Daily insulin dosage of hepatogenic diabetes group was less than that of pure diabetes mellitus group. 4. The incidence of spontaneous bacterial peritonitis,upper gastrointestinal bleeding, hepatic encephalopathy in both hepatogenic diabetes group and primary diabetes mellitus group is higher than that of pure hepatic cirrhosis group, the comparison of the incidence of hepatorenal syndrome and hepatic cell carcinoma among the three groups have no difference. 5. There is no difference in biochemical indicators of liver among hepatogenic diabetes group,primary diabetes mellitus group and pure hepatic cirrhosis group. 6. The albumin and FPG in both group of hepatogenic diabetes group and primary diabetes mellitus group have negative linear correlation.