Development of Diabetes Mellitus in Alcoholic Cirrhotic Patients

Background: Diabetes mellitus and chronic liver disease (CLD) have a complex bidirectional relationship. Up to 80% of patients with liver cirrhosis experience glucose metabolism disorders, known as "hepatogenous diabetes". Coexistence accelerates liver damage and increases mortality risk, making specialized, individualized management essential. The damaged liver struggles to clear insulin and store glucose, leading to peripheral insulin resistance and impaired glucose tolerance (IGT). Type 2 diabetes promotes chronic inflammation, fibrosis, and oxidative stress, which accelerate the progression of CLD to cirrhosis and increase the risk of hepatocellular carcinoma. Traditional diagnostic markers are often skewed in CLD patients. Fasting blood glucose may be artificially low due to decreased glucose production by the failing liver. Glycosylated haemoglobin (HbA1c) is generally unreliable because of shortened red blood cell lifespans and anemia in advanced liver disease. Oral Glucose Tolerance Testing (OGTT) is the most accurate diagnostic tool for these patients. In management, focus should be on frequent, small meals with a balance of complex carbohydrates and proteins. Strict fasting or severe calorie restriction should be avoided to prevent malnutrition and muscle wasting. Metformin once thought to be strictly contraindicated in severe liver disease due to lactic acidosis risk, recent studies suggest it can be safely used in early CLD and may even reduce the risk of hepatocellular carcinoma. Insulin is often the preferred choice, particularly in advanced cirrhosis. Certain GLP-1 receptor agonists and SGLT2 inhibitors are showing promise due to their efficacy in reducing liver fat and fibrosis, though careful monitoring is required depending on the severity of the liver impairment. The aim and objective is to determine prevalence of Diabetes Mellitus in Alcoholic liver disease patients at tertiary care center of Northern India. Material and Methods: Over the course of 10 years, from May 1, 2016, to April 30, 2026, a prospective study was carried out at the Department of Medical Gastroenterology, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak. The 100 confirmed alcoholic liver disease (ALD) patients were enrolled in the study, and all were cirrhotic (fibroscan greater than 12.2 Kpa). Only those patients who had no past history of diabetes mellitus and at-least three years or more duration of being diagnosed with ALD, were enrolled in the study. This was done with aim of giving ample time for developing diabetes mellitus, so as to decrease false negative rate. Patients were labelled to be having diabetes mellitus on basis of clinical symptoms (Polydipsia, Polyphagia, Polyuria), blood sugar fasting & post prandial levels (>126 mg/dl and >180 mg/dl respectively) and HbA1C (>6). Results: Our all 100 ALD patients were male, predominantly belonging to rural background. The maximum percentage (82.67%) were above 40 yrs of age; the peak age group was between 41-60 yrs (52%). Out of these 100 patients, 16 (16%) developed diabetes mellitus. The average time period for developing DM after being diagnosed as cirrhotic varied between 3- 6 years. Conclusion: Patients of ALD are at high risk of developing type 2 diabetes mellitus, mainly in cirrhotic stage. The prevalence of DM increase with progression of decompensation. Hence, it’s anticipation by the treating team is mandatory which can be achieved by regularly testing for both fasting and post-prandial sugar levels, along with HbA1C levels. Moreover, patients should also be motivated for being watchful for polydipsia, polyurea and polyphagia which are manifestations of development of diabetes mellitus. Timely detection and appropriate treatment of diabetes mellitus can lead to reduction in morbidity and mortality associated not only with chronic liver disease but also with diabetes mellitus.

Keywords: Diabetes Mellitus, HbA1C, Blood Sugar level, Alcohol, Polydipsia, Polyphagia.