Puri Pankaj, Kotwal Narendra
Fortis Escorts Liver and Digestive Diseases Institute, New Delhi, 110025, India.
Armed Forces Clinic, New Delhi, 110011, India.
J Clin Exp Hepatol. 2022 Mar-Apr;12(2):560-574. doi: 10.1016/j.jceh.2021.09.010. Epub 2021 Sep 16.
The management of diabetes in cirrhosis and liver transplantation can be challenging. There is difficulty in diagnosis and monitoring of diabetes as fasting blood sugar values are low and glycosylated hemoglobin may not be a reliable marker. The challenges in the management of diabetes in cirrhosis include the likelihood of cognitive impairment, risk of hypoglycemia, altered drug metabolism, frequent renal dysfunction, risk of lactic acidosis, and associated malnutrition and sarcopenia. Moreover, calorie restriction and an attempt to lose weight in obese diabetics may be associated with a worsening of sarcopenia. Many commonly used antidiabetic drugs may be unsafe or be associated with a high risk of hypoglycemia in cirrhotics. Post-transplant diabetes is common and may be contributed by immunosuppressive medication. There is inadequate clinical data on the use of antidiabetic drugs in cirrhosis, and the management of diabetes in cirrhosis is hampered by the lack of guidelines focusing on this issue. The current review aims at addressing the practical management of diabetes by a hepatologist.
肝硬化和肝移植患者的糖尿病管理颇具挑战性。由于空腹血糖值较低且糖化血红蛋白可能并非可靠指标，糖尿病的诊断和监测存在困难。肝硬化患者糖尿病管理面临的挑战包括认知功能障碍的可能性、低血糖风险、药物代谢改变、频繁出现的肾功能不全、乳酸酸中毒风险以及相关的营养不良和肌肉减少症。此外，肥胖糖尿病患者的热量限制和减重尝试可能会使肌肉减少症恶化。许多常用的抗糖尿病药物在肝硬化患者中可能不安全或伴有低血糖的高风险。移植后糖尿病很常见，可能由免疫抑制药物导致。关于抗糖尿病药物在肝硬化患者中的使用，临床数据不足，且缺乏针对该问题的指南，这阻碍了肝硬化患者糖尿病的管理。本综述旨在探讨肝病专家对糖尿病的实际管理方法。
