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Cirrhosis and diabetes

II. Association of impaired glucose tolerance with portal-systemic shunting in Laennec's cirrhosis

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Abstract

The increased frequency of diabetes in patients with cirrhosis was investigated by performing oral and intravenous glucose tolerance tests (GTT) and glucose clearance rate (KG) in 145 cirrhotic patients, including some with overt diabetes and some with portacaval anastomoses (PCA) as well as in appropriate normal and diabetic control groups.

The oral GTT was abnormal in 80% of the patients with cirrhosis; the intravenous GTT was impaired in only 19% and KG values were abnormal in 68%. Conventional intravenous GTT was clearly too insensitive to detect even moderate degrees of glucose intolerance. The oral GTT and glucose clearance rate, which are too sensitive for the clinical detection of diabetes in the presence of cirrhosis, demonstrate that some aspect of cirrhosis is systematically responsible for impaired glucose metabolism in the great majority of cirrhotic patients.

Abnormal glucose tolerance was associated with several clinical and laboratory features of cirrhosis which are manifestations of portal hypertension and portal-systemic shunting. Statistically significant correlations were found between impaired glucose tolerance and the presence of ascites, esophageal varices, impaired ammonia tolerance and hypoalbuminemia. There was no apparent association with other features of cirrhosis such as jaundice, spiders, or hepatosplenomegaly or other tests of liver function which reflect less closely portal hypertension.

In 15 cirrhotic patients who were studied before and after PCA, improvement in glucose tolerance was observed after PCA in all 3 who had overt diabetes. In the other 12 patients, glucose tolerance became more abnormal after PCA than before.

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Authors and Affiliations

  1. From the Medical Service, Veterans Administration Hospital, West Haven, Conn

    Harold O. Conn MD, William Schreiber MD & Stephen G. Elkington MD

  2. the Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn

    Harold O. Conn MD, William Schreiber MD & Stephen G. Elkington MD

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  2. William Schreiber MD
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  3. Stephen G. Elkington MD
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Conn, H.O., Schreiber, W. & Elkington, S.G. Cirrhosis and diabetes. Digest Dis Sci 16, 227–239 (1971). https://doi.org/10.1007/BF02235244

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