Carotid intima-media thickness in patients with liver cirrhosis associated with diabetes mellitus

Prevalence of diabetes in liver cirrhosis: A systematic review and meta-analysis

An association between diabetes mellitus (DM) and liver cirrhosis is well-known, but estimates of the prevalence of DM in patients with liver cirrhosis vary widely. A systematic review was undertaken to determine the prevalence of DM in adult patients with liver cirrhosis. The Medline, EMBASE, and Cochrane Library databases were searched for peer-reviewed studies published in English (1979-2017) that investigated the prevalence of diabetes in adult patients with cirrhosis. Pooled estimates of prevalence of DM were determined for all eligible patients and according to aetiology and severity of liver disease. Fifty-eight studies satisfied criteria for inclusion, with 9705 patients included in the pooled prevalence analysis. The overall prevalence of DM was 31%. The prevalence of DM was highest in patients with nonalcoholic fatty liver disease (56%), cryptogenic (51%), hepatitis C (32%), or alcoholic (27%) cirrhosis. For assessing prevalence of DM as a function of severity of liver disease, evaluable data were available only for hepatitis C and hepatitis B cirrhosis. DM may be more prevalent in cirrhosis than previously thought. This has implications for prognosis and treatment in these patients.

Effect of Methanolic Leaf Extract of Talinum triangulare (Jacq). Willd. on Biochemical Parameters in Diet induced Dyslipidemia Wistar Rats

OBJECTIVE

To investigate the effect of methanolic leaf extract of Talinum triangulare on hematological parameters, enzymatic and non-enzymatic antioxidant status, and serum lipid in Wistar rats fed standard laboratory, or 2% cholesterol-enrich diet.

MATERIAL AND METHODS

Wistar rats (180-210g) divided into six groups of six animals (males) each were fed 2% cholesterol-enriched diet and orally treated with 0.9% saline or extract of Talinum triangulare (250, 500, and 1000 mg/kg per body weight) daily for eight weeks. Lipid profile, lipid peroxidation (MDA), hematological parameters, and their functional indices and serum antioxidant enzymes (catalase, glutathione -S-transferase, and superoxide dismutase) activities and glutathione status were assessed in normal and diet-induced hypercholesterolemic extract treated rats and compared with the rats treated with 100 mg/kg per bwt standard drug gemfibrozil.

RESULTS

A significant (P < 0.05) increase in lipid profile (total glyceride, total cholestrol, low-density lipoprotein, and very low-density lipoprotein), MDA and reduction (P < 0.05) in enzymatic and nonenzymatic antioxidant status coupled with alterations in hematological parameters was observed in the serum of hypercholesterolemic rats when compared with animals on a normal diet. Coadministration of methanolic leaf extracts of Talinum triangulare or gemfibrozil significantly (P < 0.05) restored the elevated serum lipid profile, MDA, and the deranged hematological parameters to near normal. The extract also protected against hypercholesterolemic-induced diminished enzymatic and nonenzymatic antioxidant status. The activities of the plant extract are dose (250, 500, and 1000 mg/kg) dependent and it compared favorably with the standard drug gemfibrozil.

CONCLUSION

The present study suggested that the extract of Talinum triangulare might protect against hypercholesterolemic-induced altered lipid profiles, oxidative stress, and also improve the status of antioxidant defense system and hematopoiesis.

SUMMARY

Elevated lipid profile (total glyceride, total cholestrol, low-density lipoprotein, and very low-density lipoprotein), lipid peroxidation (MDA), and reduced enzymatic and nonenzymatic antioxidant status coupled with alterations in hematological parameters was observed in the serum of hypercholesterolemic rats when compared with animals on a normal dietCoadministration of methanolic leaf extracts of Talinum triangulare significantly (P < 0.05) restored the elevated serum lipid profile, MDA, and the deranged hematological parameters to near normal.The extract also protected against hypercholesterolemic-induced diminished enzymatic and bnonenzymatic antioxidant status.The activities of the plant extract was dose-dependent and it compared favorably with the standard drug gemfibrozil. Abbreviations used: Lipid peroxidation (MDA), (catalase (CAT), glutathione-S-transferase (GST), superoxide dismutase (SOD), glutathione (GSH), Thrombocytes indices (PLT), Red blood cell (RBC), Packed cell volume (PVC), Mean corpuscular hemoglobin(MCH), Mean corpuscular hemoglobin concentration (MCHC), Total glyceride (TG), Very low density lipoprotein (VLDL), Total cholesterol (TC), Low density lipoprotein (LDL), High density lipoprotein (HDL) and 3-Hydroxy-3-methyl-glutaryl-CoA reductase(HMG-CoA).

Efficacy of glargine in management of hepatogenic diabetes

AIM: To assess the efficacy of glargine in the management of hepatogenic diabetes.

METHODS: Eighty-two patients with hepatogenic diabetes treated with glargine were included in the study. The insulin dose was adjusted according to fasting blood glucose (FBG) till discharge. FBG, 2 h postprandial blood glucose (2 h PBG) and glycosylated hemoglobin (HbAlc) were monitored for 24 wk. HbAlc and blood glucose levels were compared before and after treatment.

RESULTS: The FBG, 2 h PBG and HbAlc were significantly decreased after treatment (FBG: 6.35 mmol/L ± 1.47 mmol/L vs 10.52 mmol/L ± 3.13 mmol/L, P < 0.05; 2 h PBG: 9.81 mmol/L ± 3.14 mmol/L vs 17.51 mmol/L ± 4.33 mmol/L, P < 0.05; HbA1c: 7.54% ± 1.31% vs 10.65% ± 1.43%, P < 0.05). There were no significant differences in the above parameters between 12 and 24 wk after treatment (FBG: 6.47 mmol/L ± 1.25 mmol/L vs 6.35 mmol/L ± 1.47 mmol/L, P > 0.05; 2 h PBG: 8.91 mmol/L ± 2.76 mmol/L vs 9.81 mmol/L ± 3.14 mmol/L, P > 0.05; HbA1c: 7.28% ± 1.12% vs 7.54% ± 1.31%, P > 0.05). The incidence of hypoglycemia was low, which occurred only once.

CONCLUSION: Glargine therapy is effective and safe for hepatogenic diabetes.

Carotid intima-media thickness progression predicts cardiovascular events in Japanese patients with type 2 diabetes

AIMS

The aim of this retrospective study was to investigate the relationship between progression of carotid intima-media thickness (cIMT) and cardiovascular events in Japanese patients with type 2 diabetes mellitus (T2DM) and free of history of cardiovascular events.

METHODS

Patients with T2DM (n=342) without history of cardiovascular events whose cIMT was assessed more than twice by ultrasonography were recruited and followed up for cardiovascular events.

RESULTS

During a mean follow-up of 7.6 years, 56 (16.4%) cardiovascular events (27 coronary events and 29 cerebrovascular events) were recorded. Multivariate analysis with the Cox proportional hazard model identified cIMT progression as a significant determinant of cardiovascular events, with a hazard ratio (HR) of 2.24 (95% confidence interval; CI, 1.25-4.03, P<0.01), in addition to baseline cIMT. The Kaplan-Meier curves also showed significantly higher event rate in patients with high cIMT progression compared with those with low cIMT progression (log-rank χ(2)=6.65; P<0.01). Furthermore, the combination of high baseline cIMT and high cIMT progression was a significant predictor of cardiovascular events.

CONCLUSION

Our findings suggest that cIMT progression, in addition to baseline cIMT, is a predictor of cardiovascular events in patients with T2DM without history of cardiovascular events, and that the combination of cIMT progression and baseline cIMT has a strong predictive power for such events.

Type 2 diabetes mellitus and chronic hepatitis C: which is worse? Results of a long-term retrospective cohort study

BACKGROUND

The long-term outcome in patients with chronic hepatitis C and type 2 diabetes mellitus treated with interferon and ribavirin is unclear. We compared incidence of liver-related events and mortality rates between hepatitis C virus-positive patients with or without diabetes mellitus, and the incidence of diabetes-related events between diabetic patients with and without hepatitis C.

METHODS

Retrospective study of 309 patients with chronic hepatitis C. Incidence of liver-related events, diabetes-related events and mortality rates were assessed over a mean follow-up of 11.02±4.9 years.

RESULTS

50 (16%) chronic hepatitis C patients had diabetes mellitus. Diabetics showed a higher number of diabetes- and liver-related events than non-diabetics (10% vs 1.5%, p=0.006; 18% vs 5.7%, p=0.007, respectively) with a mortality of 14% vs 1.5% (p=0.0003). Baseline cirrhosis (p=0.002) and non-sustained virological response (p=0.01) were independent risk factors for liver events; diabetes mellitus (p=0.01) and hypertension (p=0.0017) were independent factors for diabetes-related events.

CONCLUSIONS

In patients with chronic hepatitis C, comorbidity with diabetes mellitus was associated with a higher mortality rate and incidence of liver/diabetes-related events. Independent risk factors for liver-related events were the non-response to antiviral therapy and cirrhosis at baseline.

Coronary artery disease in patients with liver cirrhosis

BACKGROUND

The prevalence of coronary artery disease (CAD) has been reported to be low in patients with liver cirrhosis. Previous studies have, however, included mostly patients with cirrhosis due to hepatitis C. We aimed to determine the prevalence and predictive factors of CAD in a cohort of consecutive patients with cirrhosis of various etiologies compared to the general population.

METHODS

A total of 127 patients with cirrhosis were evaluated for a history of CAD and cardiovascular risk factors. Arterial blood pressure, fasting plasma glucose, and serum cholesterol were measured. Nutritional status was assessed by anthropometry and estimation of recent weight change. A group of 203 subjects from the general population with similar age and gender distribution, as well as smoking habits as the cirrhotic patients, served as controls.

RESULTS

CAD was more common in cirrhotics compared to controls (20% vs. 12%, P = 0.001). Compared to controls, cirrhotics had lower mean arterial blood pressure and serum cholesterol and a higher prevalence of diabetes, but did not differ significantly in the prevalence of hypertension or family history for CAD. In regression analysis, CAD was independently related to diabetes (odds ratio [OR] 5.47, 95% confidence interval [CI] 2.44-12.28), but not to liver cirrhosis. In the cirrhosis group, only alcoholic cirrhosis (OR 9.50, 95% CI 1.08-83.4) and age (OR 1.23 per year, 95% CI 1.06-1.43) were independently related to CAD.

CONCLUSIONS

Liver cirrhosis, per se, does not seem to confer a protective effect against CAD. In cirrhotics, older age and alcoholic etiology were independently related to CAD.