Insulin resistance in elderly patients with liver cirrhosis and diabetes mellitus / 中华老年医学杂志

ABSTRACT

Objective To investigate the relationship between insulin resistance and hepatic function in elderly liver cirrhosis (LC)patients with diabetes (LC-DM)and to provide evidence for clinical treatment.Methods Thirty cases of elderly LC,30 cases of elderly LC-DM,30 younger patients (＜60 years)with LC-DM and 30 healthy subjects were enrolled.Levels of fasting plasma glucose(FPG)and fasting plasma insulin(FINS)were examined to evaluate the homeostasis model for assessment of insulin resistance (HOMA-IR),which was used for comparison between the groups.Moreover,the relationship between HOMA-IR and the Child Pugh classification was also analyzed.Results Patients in the elderly LC group were associated with significantly higher levels of FINS (9.58±3.62 vs.6.03±1.99 mU/L,P＜0.05)and HOMA-IR(2.47±0.88 vs.2.12±0.99,P＜0.05),compared with the control group.Meanwhile,levels of FPG,FINS and HOMA-IR in the elderly LC-DM group were (5.83 ± 1.40) mmol/L,(15.63 ± 6.37) mU/L and 6.33 ± 2.59,respectively,significantly higher than those[(5.03±0.83)mmol/L,(9.58±3.62)mU/L,2.47±0.88]in the elderly LC group and those[(5.31±0.58)mmol/L,(6.03±1.99)mU/L,2.12±0.99]in the control group (all P＜0.05).However,levels of FPG,FINS and HOMA IR were similar between the elderly LC-DM group and the younger LC-DM group(P＞0.05).In the elderly LC-DM group,more patients(66.7 ％) had Child-Pugh C liver function compared with the elderly LC group(36.7 ％)and the younger LC-DM group(40.0％)(both P＜0.05).Of those in the LC and LC-DM groups,levels of HOMA IR were 7.39±2.25 in patients with Child-Pugh C,which were significantly higher than those in patients with Child Pugh B function(4.90± 1.76) and with Child Pugh A liver function(2.69± 1.02)(both P＜0.05).Conclusions Hyperinsulinemia and insulin resistance are more pronounced in elderly LC DM than in elderly LC,with poor liver function and prognosis.