Prevalence of insulin resistance in cirrhosis of liver

Hardeep Singh Deep, Navida Babbar, Devinder Singh Mahajan


Background: Liver plays a central role in glucose homeostasis. Chronic liver disease is associated with an increased incidence of insulin resistance (IR) and Diabetes Mellitus. Diabetes that develops as a complication of cirrhosis of liver is known as ‘Hepatogenous diabetes (HD)’. This study was conducted to study the prevalence of insulin resistance in liver cirrhosis.

Methods: One Hundered (100) non-diabetic patients of liver cirrhosis considering the inclusion and exclusion criteria and visiting both indoor and outpatient department of medicine, SGRDIMSAR were included in the study. All cirrhotic patients irrespective of etiology were subjected to fasting plasma glucose level and fasting plasma insulin levels and insulin resistance was calculated by HOMA-IR method. Study was statistically analyzed.

Results: 79 out of 100 patients were found to have insulin resistance and increase in prevalence with grades of child pugh score were noted.

Conclusions: Keeping in view the results of the study, we conclude that FPG and HbA1c are not sufficient in detecting glucose metabolism disorders in cirrhosis. As insulin resistance can be used as an important prognostic marker in patients with cirrhosis of liver, serum insulin levels can be recommended as routine investigation in these patients. Diabetes mellitus increases the risk of HCC in cirrhosis patients. So, by early detection of diabetes mellitus by calculating insulin resistance with HOMA-IR method we can prevent progression of disease to development into HCC.


Hepatogenous diabetes, Insulin resistance, Liver cirrhosis

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WHO. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus. Geneva, World Health Organization. 1999. Available at

Blanco DVC, Gentile S, Marmo R, Carbone L, Coltorti M. Alterations of glucose metabolism in chronic liver disease. Diabetes Res Clin Pract. 1990;8(1):29-36.

Pazhanivel M, Jayanthi V. Diabetes mellitus and cirrhosis liver. Minerva Gastroenterol Dietol. 2010;56(1):7-11.

Holstein A, Hinze S, Thiessen E, Plaschke A, Egberts EH. Clinical implications of hepatogenous diabetes in liver cirrhosis. J Gastroenterol Hepatol. 2002;17(6):677-81.

Hickman IJ, Macdonald GA. Impact of diabetes on the severity of liver disease. Am J Med. 2007;120(10):829-34.

Barthel A, Schmoll D. Novel concepts in insulin regulation of hepatic gluconeogenesis. Am J Physiol Endocrinol Metab. 2003;285:E685-92.

Zein NN, Abdulkarim AS, Wiesner RH, Egan KS, Persing DH. Prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C, alcohol or cholestatic disease. J Hepatol. 2000;32(2):209-17.

Romero-Gómez M. Insulin resistance and hepatitis C. World J Gastroenterol. 2006;12(44):7075-80.

Fujiwara F, Ishii M, Taneichi H, Miura M, Toshihiro M, Takebe N, et al. Low incidence of vascular complications in patients with diabetes mellitus associated with liver cirrhosis as compared with type 2 diabetes mellitus. Tohoku J Exp Med. 2005;205(4):327-34.

Bianchi G, Marchesini G, Zoli M, Bugianesi E, Fabbri A, Pisi E. Prognostic significance of diabetes in patients with cirrhosis. Hepatol. 1994;20(1):119-25.

Hassan MM, Curley SA, Li D, Kaseb A, Davila M, Abdalla EK, et al. Association of diabetes duration and diabetes treatment with the risk of hepatocellular carcinoma. Cancer. 2010;116(8):1938-46.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412-9.

Chitturi S, Abeygunasekera S, Farrell GC. NASH and insulin resistance: insulin hypersecretion and specific association with the insulin resistance syndrome. Hepatol. 2002;35(2):373-9.

Hickman IJ, Macdonald GA. Impact of diabetes on the severity of liver disease. Is J Med. 2007;120(10): 829-34.

Barthel A, Schmoll D. Novel concepts in insulin regulation of hepatic gluconeogenesis. Am J Physiol Endocrinol Metab. 2003;285(4):E685-92.

Hui JM. Insulin resistance is associated with chronic hepatitis C and virus infection fibrosis progression Gastroenterol. 2003;125(6):1695-704.

Erice E, Llop E, Berzigotti A, Abraldes JG, Conget I, Seijo S. Insulin resistance in patients with cirrhosis and portal hypertension. Am J Physiol Gastrointest Liver Physiol. 2012;302(12):G1458- 65.

Goswami A, Bhargava N, Dadhich S, Kulamarva G. Insulin resistance in euglycemic cirrhosis. Dr Sampurnanand Medical College, Jodhpur, India Ann Gastroenterol. 2014;27(3):1-7

Mukherjee S, Sarkar BS, Das KK, Banerjee A. A cross-sectional study on occurrence of type 2 diabetes among patients admitted with chronic liver diseases in a Medical College in Kolkata. Int J Med Pub Health. 2013;3(1):44-7.

Gharavi A, Mohammadi AHA, Ziaee A, Sarookhani MR, Javadi A, Haghazali S. Investigation of insulin resistance in patients with liver cirrhosis and its relationship with severity of disease. J Qazvin Univ Med Sci. 2008;12(1):27-34.