GLUCOSE-INTOLERANCE IN LIVER-CIRRHOSIS - ROLE OF HEPATIC AND NONHEPATIC INFLUENCES

Oral glucose tolerance was tested in a heterogeneous group of 108 pati ents with liver cirrhosis. Data were compared with those from 181 subj ects without liver disease (44% normal, 35% impaired glucose tolerance and 21% type 2 diabetes mellitus). In cirrhosis, 27% of the patients had normal, 36% had impaired glucose tolerance, and 37% were diabetic. There was no association between glucose intolerance or diabetes and the aetiology of cirrhosis, the duration of the disease, the biochemic al indicators of hepatocyte damage, cholestasis and/or liver function. Only weak associations were found between the results of quantitative liver functions tests (caffeine, xylocaine (R), indocyanine green) an d basal and post load glucose and insulin concentrations. Cirrhotics w ith Ist degree relatives with type 2 diabetes mellitus (n = 16) did no t show an increased prevalence of diabetes. Older and/or malnourished patients were more frequently glucose intolerant. Using the plasma glu cose concentration 120 minutes after glucose load as the dependent var iable, multivariate regression analysis showed that 54% of its varianc e is associated with the following variables: basal plasma glucose (36 %) and free fatty acid concentration (5%), age (3%), basal glucose oxi dation rate (3%), muscle mass (3%) and plasma free glycerol at 120 min utes after glucose load (3%). By contrast, the clinical state of the p atients (i. e. the CHILD-Pugh score) accounted for only 2% of the vari ance. We conclude that glucose tolerance is variable in cirrhosis. Aft er manifestation of liver disease, glucose intolerance or diabetes can not be explained by the clinical, histological or biochemical signs of liver disease.