Hepatogenous diabetes: Knowledge, evidence, and skepticism

Table 3 Studies depicting clinical impact of diabetes mellitus/hepatogenous diabetes in patients with liver cirrhosis

Ref.	Design	n	Main outcomes/remarks
Bianchi et al[112]	Retro-prospective	354	5 yr survival: 41% with DM and 56% without DM (P = 0.005)
Holstein et al[31]	Prospective cohort	52	51% of HD patients died within median of 5.7 yr after diagnosis of DM. Remark: No data on non-diabetic control
Moreau et al[136]	Prospective cohort	75	Survival in patients with and without DM: 18% and 58%, respectively
Sigal et al[97]	Cross-sectional	65	Incidence and severity of HE was higher in diabetics and DM was an independent risk factor for HE (P = 0.0008). Remark: study involved only HCV cirrhosis
Nishida et al[25]	Prospective cohort	56	5 yr survival was 94%, 68% and 56%, with NGT, IGT and DM, respectively
Tietge et al[114]	Case-control study	100	Pre-transplant IGT or DM was risk factor for post-LT DM. Remark: Only 31 patients were prospectively evaluated
Jeon et al[29]	Prospective cohort	195	HD correlated significantly with HVPG and VH. Post-prandial hyperglycemia correlation with risk of VH in 6 mo
García-Compeán et al[113]	Prospective cohort	100	5 yr cumulated survival was lower in IGT patients than NGT (31.7% vs 71.6%, P = 0.02)
Elkrief et al[106]	Retrospective cohort	348	DM was independently associated with ascites, infections, HE, HCC and mortality. Remarks: Only HCV cirrhosis studied
Yang et al[104]	Prospective cohort	146	DM was among independent predictors of VH (OR = 4.90)
Jepsen et al[98]	Database analysis	863	Diabetic patients had a higher episode of first-time overt HE and HE progression beyond grade 2 than non-diabetics. Remarks: Original trials used vaptan which could be a confounder
Khafaga et al[137]	Prospective case-control	60	Proportion of VH (46.4% vs 10%), HE (36% vs 10%) and mortality (16.6% vs 6.7%) was higher among diabetics compared to non-diabetic LC
Qi et al[105]	Retrospective	145	In-hospital mortality was 20.6% in diabetics and 4.3% in nondiabetics (P = 0.003)
Hoehn et al[116]	Retrospective	12442	Diabetic recipients had longer hospitalization (10 vs 9 d) and higher peri-transplant mortality (5% vs 4%)
Yang et al[110]	Retrospective cohort	739	DM increased the risk of HCC in non-HCV cirrhosis (HR = 2.1)
Routhu et al[100]	Retrospective cohort	895	DM was an independent predictor of HE
Ramachandran et al[23]	Prospective cohort	222	HD patients had higher incidence of gall stones (27% vs 13%) and urinary infection (28% vs 7%), compared to those without DM
Tergast et al[108]	Prospective	475	DM patients had an increased risk for SBP (HR = 1.51), especially when HbA1c values ≥ 6.4%
Wang et al[22]	Retrospective	207	Rebleeding rate following variceal endotherapy was higher (approximately 5 times) in diabetics, including HD, than non-diabetics at 1, 3, and 6 mo
Rosenblatt et al[109]	Retrospective (National database)	906559	Uncontrolled DM was associated with an increased risk of bacterial infection (OR = 1.33) and death (OR = 1.62)
Labenz et al[138]	Prospective cohort s	240	DM was independently associated with covert HE. The risk of HE and overt HE was more pronounced when HbA1c ≥ 6.5%

DM: Diabetes mellitus; HCC: Hepatocellular carcinoma; HCV: Hepatis C virus; HD: Hepatogenous diabetes; HE: Hepatic encephalopathy; HR: Hazard ratio; IGT: Impaired glucose tolerance; NGT: Normal glucose tolerance; OR: Odds ratio; VH: Variceal hemorrhage.