Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives

Table 3 Prospective and retrospective studies depicting implications of diabetes on mortality of patients with liver cirrhosis

Ref.	Design	Population	Outcomes	Limitations
Bianchi et al[3], Italy, 1994	Retro-prospective	354 LC, 98 with DM	5-yr survival rate: DM: 41%, non-DM 56%	Diagnosis of DM not standardized
Holstein et al[4], Germany, 2002	Prospective	52 LC, 71% with DM	5.6-yr survival rate after diagnosis of LC: 51% of HD patients. 80% of deaths were cirrhosis-related causes	Small sample size. Comparative outcome data of non-DM patients not available
Moreau et al[79], France, 2004	Prospective	75 LC and refractory ascites	DM, older age, and HCC were predictors of poor survival. The survival rate of patients without DM was higher	OGTT was not used to diagnose DM
Nishida et al[48], Japan, 2006	Prospective	56 LC, 38% diabetics	The 5-yr survival rate was 94%, 68% and 56%, with NGT, IGT and DM, respectively	Small sample size
Quintana et al[80], México, 2011	Prospective	110 compensated LC, 45% diabetics	2.5 yr cumulated survival years: DM: 48 vs non-DM: 69% (P < 0.05). DM was not predictor of death	Maybe DM death- prediction capability was masked by Child-Pugh C score
García-Compeán et al[78], México, 2014	Prospective	100 compensated LC and normal FPG	Patients with IGT + DM had lower 5-yr cumulated survival rate. Death causes in 90 % were cirrhosis related	Small sample size
Elkrief et al[40], Canada, 2014	Retrospective	348 HCV-LC, 40% diabetics	DM significantly associated with ascites, renal dysfunction, infections, HCC and mortality during the follow-up period	Retrospective. Potential errors in the diagnosis of DM
Khafaga et al[67], Egypt, 2015	Case-control	60 LC, 50% diabetics	Diabetics had higher incidence of VH, hospitalizations, HE and mortality rate	Small sample size
Qi et al[66], China, 2015	Retrospective	145 LC, 29 diabetics	In-hospital mortality was higher in diabetics	Small number of patients
Hoehn RS et al[82], United States, 2015	Retrospective	12442 pos- LT, 24% with DM	Diabetic recipients had longer hospitalization, higher peri-transplant mortality and 30-d readmission rates	More diabetic patients were on haemodialysis and received allografts from older donors
Rosenblatt et al[70], United States, 2021	Retrospective	906559 LC with DM, and 109694 uncontrolled DM	Uncontrolled DM associated with increased risk of bacterial infection and increased risk of death in elderly patients	Subject to administrative error. Criteria for DM was not standardized

DM: Diabetes mellitus; FPG: Fasting plasma glucose; HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; HD: Hepatogenous diabetes; HE: Hepatic encephalopathy; IGT: Impaired glucose tolerance; NGT: Normal glucose tolerance; OGTT: Oral glucose tolerance test; VH: Variceal hemorrhage; LT: Liver transplantation; LC: Liver cirrhosis.