Title: Hepatic Dysfunction in Type-2 Diabetes Mellitus
Authors: Dr Butungeshwar Pradhan, Dr Jyotiprakash Patel
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.99
Abstract
Background: Type-2 Diabetes Mellitus (T-2 DM) patients, with hyperglycemia, have increased intracellular glycogen storage and Free Fatty Acid (FFA) accumulation in hepatocyte in response to insulin resistance leading to increase glycogen synthesis and FFA production which are toxic to hepatocytes, causing hepatocellular injury, fatty changes in liver and elevation of aminotransferases levels. Raised liver enzymes are marker of hepatocellular injury and can be used as an indirect evidence of insulin resistance in Type-2 DM.
Objective: To know the extent of liver structure and functions are modified in Type-2 DM patients, by estimating serum biochemical analysis of liver functions in relation to glycemic status and Ultrasound study of liver to detect fatty changes.
Material and Method: This was an observational cross sectional study on 100 T2DM patients and 100 age and sex matched controlled non-diabetic cases attending the Department of Medicine, VSSIMSAR. BURLA from October 2017 to November 2019. Biochemical tests were done for assessment of glycemic status were, FBS, PPBS, HbA1C and for liver functions, total, direct and indirect bilirubin, ALT, AST, ALP, Total protein and serum Albumin. Ultrasonography study of liver was done for detection of hepatic structure and pathology.
Result: Total bilirubin was elevated in 13% and Direct bilirubin elevated in 36%, AST, ALT, ALP was increased in 46%, 62%, and 46% cases respectively from normal cutoff values. Serum albumin value was decreased in 44%. On USG study 16 T-2DM patients (17.39%) had Fatty liver changes. Type-2 DM patients with fatty liver changes had raised liver enzymes, PPBG and HbA1C, suggesting high insulin resistance state in comparison to patients without fatty liver changes..
Conclusion: Mild raised liver enzymes and fatty liver changes may be used as an indirect biomarker of insulin resistance in type-2 DM.
Keywords: Type-2 Diabetes, Liver Functions, Insulin resistance, Fatty liver, ALT, AST, ALP, HbA1c.
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