Management of diabetes mellitus in patients with cirrhosis: An overview and joint statement - 02/11/21

Doi : 10.1016/j.diabet.2021.101272

Jerome Boursier ^a,^b,^⁎ , Rodolphe Anty ^c,^d,^e, Claire Carette ^f, Bertrand Cariou ^g, Laurent Castera ^h,ⁱ, Cyrielle Caussy ^j,^k, Helene Fontaine ^l, Armand Garioud ^m, Pierre Gourdy ^n,^o, Bruno Guerci ^p, Maeva Guillaume ^q,^r, Niasha Michot ^s, Anne Minello ^t, Dann J Ouizeman ^c, Lawrence Serfaty ^u, Fabrice Bonnet ^v, Bruno Vergès ^w,^x, Jean-Michel Petit ^w,^x
on behalf of
AFEF and SFD^¹
AFEF: Association Française pour l'Etude du Foie (French Association for the Study of the Liver)
, ^{^{2
SFD: Société Francophone du Diabète (Francophone Diabetes Society)}}
^a Laboratoire HIFIH, Université d'Angers, Angers, France
^b Service d'Hépato-Gastroentérologie et Oncologie Digestive, Centre Hospitalier Universitaire d'Angers, Angers, France
^c CHU de Nice, Digestive Center, Nice, France
^d INSERM, U1065, Team 8 « Complications hépatiques de l'obésité », Nice, France
^e Université Côte d'Azur, Faculté de Médecine, Nice, France
^f Hôpital Européen Georges Pompidou, Service de Nutrition, Centre Spécialisé Obésité (CSO) Ile-de-France-Sud, APHP-centre, Université de Paris, France
^g Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, FRANCE
^h Département d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris
ⁱ INSERM UMR 1149, Centre de Recherche sur l'Inflammation Paris Montmartre, Université de Paris, Clichy, France
^j Univ Lyon, CarMen Laboratory, INSERM, INRA, INSA Lyon, Université Claude Bernard Lyon 1, 69495 Pierre-Bénite, France
^k Hospices Civils de Lyon, Département Endocrinologie, Diabète et Nutrition, Hôpital Lyon Sud, 69495 Pierre-Bénite, France
^l AP-HP, Hôpital Cochin, Unité d'Hépatologie, Paris, France
^m Service d'Hépato-Gastroentérologie, Centre Hospitalier Intercommunal, GHT « Confluences », ANGH, Villeneuve-Saint-Georges, France
ⁿ Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU de Toulouse, Toulouse, France
^o Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UPS, Université Toulouse 3, Toulouse, France
^p Département d'Endocrinologie, Diabétologie, et Nutrition, Hôpital Brabois et Université de Lorraine, 54500 Vandœuvre-lès-Nancy, France
^q Clinique Pasteur, Digestive Center, Toulouse, France
^r INSERM, U1048, Equipe 9, Toulouse, France
^s Unité d'Assistance Nutritionnelle, CHRU Nancy, France
^t Département de Gastroentérologie et Hépatologie, Hôpital Universitaire François-Mitterrand, Dijon, France
^u Service d'Hépato-Gastroentérologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, France
^v Département d'Endocrinologie, Diabétologie et Nutrition, CHU Rennes, Université de Rennes 1, Rennes, France
^w Département d'Endocrinologie, Diabétologie, et Maladies Métaboliques, Hôpital Universitaire de Dijon, France
^x INSERM LNC UMR1231, Dijon, France

^⁎Corresponding author: Service d'Hépato-Gastroentérologie et Oncologie Digestive, CHU 49933 Angers Cedex 09, France.Service d'Hépato-Gastroentérologie et Oncologie DigestiveCHU 49933 Angers Cedex 09France

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Abstract

Type 2 diabetes mellitus (T2DM) is a frequent comorbidity in patients with cirrhosis that is projected to rise in prevalence due to the worldwide burden of obesity, insulin-resistance and non-alcoholic fatty liver disease. The management of T2DM in patients with cirrhosis is complex given the requirement for accurate adaptation according to the level of liver function impairment, with lack of summary of the little evidence available in the literature. Here, we summarise the data available with respect to the epidemiology and the impact of T2DM in patients with cirrhosis, as well as those on the management of T2DM in these patients. We provide guidance for the diagnosis of T2DM and the monitoring of glycaemic control in patients with cirrhosis, and for the management of nutrition and pharmacological treatments in relation to the level of liver dysfunction.

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Keywords : Cirrhosis, Diagnosis, Epidemiology, Monitoring, Pharmacological treatment, Type 2 diabetes mellitus

Abbreviations : ADA, 2h-PG, AUC, CGM, C_max, EASD, FPG, GLP-1 RAs, HbA1c, HCC, NAFLD, NASH, OGTT, SGLT2i, T2DM

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Introduction

Definitions

Epidemiology and impact of type 2 diabetes mellitus in patients with cirrhosis

Diagnosis of diabetes in patients with cirrhosis

Glucose monitoring and the glycaemic target in patients with cirrhosis

How is glycaemic control monitored in patients with diabetes and cirrhosis?

What is the glycaemic target for patients with cirrhosis?

Anti-hyperglycaemic treatment

Biguanides

Pioglitazone

Sulphonylureas and glinides

DPP-4 inhibitors

SGLT2 inhibitors

Acarbose

Glucagon-like peptide-1 receptor agonists

Insulin

Clinical studies with short-acting insulins

Clinical studies with long-acting insulins

Management of obesity, malnutrition and sarcopaenia in patients with cirrhosis and type 2 diabetes mellitus

Management of obesity in patients with cirrhosis and preserved liver function without malnutrition or sarcopaenia

Diagnosis of malnutrition in patients with cirrhosis

Nutritional management of patients with cirrhosis and malnutrition or sarcopaenia

Conclusion

Esportazione

Vol 47 - N° 5

Articolo 101272- Settembre 2021 Ritorno al numero

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Management of diabetes mellitus in patients with cirrhosis: An overview and joint statement - 02/11/21

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