Hepatogenic diabetes-current status of diagnostics and treatment

Background Patients with liver cirrhosis frequently develop disturbances of glucose metabolism, such as glucose intolerance or hepatogenic diabetes, which are caused by the hepatocellular functional loss and insulin resistance due to chronic liver disease. Discussion There are currently no recommendations comparable to guidelines on the diagnosis of and therapy for hepatogenic diabetes. Regarding basic treatment, a sufficient daily energy and protein supply should be guaranteed since the majority of patients with liver cirrhosis are malnourished. The risk of hypoglycemia must be considered carefully under pharmacological treatment of hepatogenic diabetes. Biguanide and PPAR gamma agonists are contraindicated due to side effects in liver cirrhosis. Suitable oral antidiabetics are glinides and short-acting sulfonylureas. If a sufficient diabetes adjustment does not succeed by oral antidiabetics a prandial insulin therapy using short-acting insulins or rapid-acting insulin analogues should be applied. Conclusion Optimisation of diabetic metabolic conditions is not only important to avoid typical diabetic late complications but also cirrhosis-associated complications, such as gastrointestinal bleeding, hepatic encephalopathy or the occurrence of hepatocellular carcinoma.