1Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Japan
2Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan.
3Department of General Internal Medicine, Kawasaki Medical School, Japan.
4Department of Hepatology, Graduate School of Medicine, Osaka City University, Osaka, Japan
5Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
6Department of Internal Medicine, Saga Medical School, Saga University, Saga, Japan
7Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan.
8Department of Gastroenterology, National Center for Global Health and Medicine, Tokyo, Japan.
9Department of Gastroenterology, JA Hiroshima Kouseiren General Hospital, Japan
10Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Japan
11Department of Gastroenterology, Suita City Hospital, Osaka, Japan
12Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
13Department of Molecular Biochemistry & Clinical Investigation, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
14Hepatology Center, Saiseikai Suita Hospital, Japan
*Corresponding author:Yoshio Sumida, Division of Hepatology and Pancreatology, Department of Internal Medicine, Aichi Medical University, Japan
Submission: February 03, 2020Published: February 11, 2020
ISSN : 2578-0263Volume3 Issue3
Diabetes is associated with about 30% of liver cirrhosis and affects prognosis, carcinogenesis, and the onset of complications. In cirrhosis, fasting normal and postprandial hyperglycemia are often present, and evaluation by glucose tolerance test or continuous blood glucose measurement is also considered. Although no treatment strategy has been established, if renal function is maintained, metformin will be the first choice, but for renal dysfunction cases and metformin ineffective cases, insulin will be indicated. Although the efficacy and safety of incretin-related drugs and sodium-glucose cotransporter 2 inhibitors have not been established, they can be expected to be effective in cases with obesity. On the viewpoint of preventing sarcopenia and hepatocarcinogenesis, antidiabetic drugs should be selected. Exogenous insulin should be indicated for patients with Child C grade. This review discusses antidiabetic treatments for diabetes with liver cirrhosis.
Keywords:Metformin; Insulin; Incretin; Sodium-glucose cotransporter 2; Glucagon like peptide 1
Abbreviations:GA: Glycated Albumin; CLD: Chronic Liver Disease; HCC: Hepatocellular Carcinoma; CGMS: Continuous Glucose Monitoring System; FGM: Flash Glucose Monitoring; NASH: Nonalcoholic Steatohepatitis; αGI: Alpha Glucosidase Inhibitor; SGLT2: Sodium-Glucose Cotransporter 2; DPP-4: Dipeptidyl Peptidase-4