Insulin-dependent and non-insulin-dependent glucose uptake in patients with cirrhosis of the liver

INSULIN-DEPENDENT AND NOI~I-INSULIN-DEPENDEN'r GLUCOSE UPTAKE IN PATIENTS WITH CIRRHOSIS OF THE LIVER G Marchesini, G Pacini(*), GP Bianchi, Daniela Patrono(^), C Cobelli(~). Istituto di Patologia Hedica I, Universita" di Bologna; (*)LADSEB-CNR, Padova; (~)Istituto di Elettrotecnica ed Elettronica, Universita" di Padova; and (^)Laboratorio Centralizzato, Policlinico S Orsola, Bologna. Decreased sensitivity and/or responsiveness to insulin is a very well-known feature of cirrhosis. It has been blamed for the impaired glucose tolerance which is frequently observed in these patients. Non-insulin-dependent glucose metabolism has never been studied. By means of the minimal model technique we analyzed the plasma time-courses of glucose and insulin during a frequently-sampled i . v . glucose tolerance test (IVGTT). 8.33 g of glucose/kg body weight (BW) were injected in I min and 29 blood samples were obtained in the following 4 hours. Four control subjects (age: 38-47 years, BW: 78~SE 5 kg) and 18 cirrhotic patients (age: 41-58, BW: 71±3) were studied. On the basis of changes in glucose and insulin, the model provides an estimation of insulin sensitivity (S-I), measured by the increase in the fractional disapperance of glucose per unit change in plasma insulin, and of glucose sensitivity (S-G), measured by the fractional clearance of glucose per unit increase in plasma glucose, independent of changes in plasma insulin. S-G represents the non-insulin-dependent glucose uptake. Basal glucose was similar in the 2 groups, while basal insulin was nearly doubled in the cirrhotics (P
DIABETES

AND LIVER

CIRRHOSIS

WITH AND WITHOUT

M a r m o R., L. E s p o s i t o , S. G e n t i l e . I s t i t u t o di S ~ m e i o t i c a M e d i c a Ia F a c o l t ~ Padiglione 3 80131 N a p o l i , Italy.

di

OVERT CANCER

Medicina,II

Policlinico

Gluco-metabolic a l t e r a t i o n s a r e o f t e n a s s o c i a t e d w i t h c i r r h o s i s of the ]ivem, but s o m e d i f f e r e n c e s of p r e v a l e n c e a r e r e p o r t e d (ranging f r o m 17% to 80%). These differences a r e p r o b a b l y d u e t o : a) n o n h o m o g e n e o u s s e r i e s s t u d i e d ; b) d i f f e r e n t c r i t e r i a of e v a l u a t i o n of d i a b e t e s . Our aim was to study the prevalence of a l t e r e d g l u c o s e t o l e r a n c e after oral l o a d o f 75 gr. (OGTT) in a l a r g e a n d h o m o g e n o u s s e r i e s of p a t i e n t s suffering from chronic l i v e r d i s e a s e . R e s u l t s of O G T T w e r e e v a l u a t e d according to the National Diabetes Data Group criteria (i). W e s t u d i e d 3 4 7 c i r r h o t i c patients c o n s e c u t i v e l y r e f e r r i n g to o u r I n s t i t u t e f r o m 1980 to 1985. T h e y w e r e divided into 3 s u b g r o u p s a c c o r d i n g to modified Child-Turcotte classification , def i n e d as C h i l d - A , -B, -C (CHA, C H B , C H C ) ~ a f u r t h e r g r o u p of p a t i e n t s with c i r r h o s i s a n d o v e r t c a n c e r w a s i d e n t i f i e d (CC). D i a b e t i c r e s p o n s e to O G T T was: 38% in CHA, 48% in C H B and 62% in C H C a n d 63% in CC, w i t h s i g n i f i c a n t d i f f e r e n c e o n l y b e t w e e n C H A vs C H C a n d C C (p<0.025). T h e s e d a t a show: l.a s i g n i f i c a n t l y h i g h e r p r e v a l e n c e of g l u c o m e t a b o l i c a l t e r a t i o n in cirrhotic patients t h a n in g e n e r a l population (p < 0.001); 2 . t h a t t h i s h i g h e r p r e v a l e n c e is p r e s e n t in all the cirrhotic groups; 3. an h e t e r o g e n o u s f r e q u e n c y d i s t r i b u t i o n in c i r r h o t i c p a t i e n t s w i t h i n c r e a s e of d i a b e t e s f r e q u e n cy p a r a l l e l to the e v o l u t i o n of h e p a t i c f u n c t i o n a l d e f i c i e n c y ; 4. an e l e v a t e d p r e v a l e n c e of d i a b e t e s in p a t i e n t s w i t h CC s i m i l a r to that d e c o m p e n s a t e d cirrhotic patients. i) N a t i o n a l D i a b e t e s D a t a Group. D i a b e t e s 1979; 2 8 , 1 0 3 9 57, 1979.

$143