{Reference Type}: Clinical Study
{Title}: Subclinical diabetes confirmed by 75-g OGTT influence on the prognosis of decompensated cirrhosis.
{Author}: Kang SH;Kim MY;Han SK;Baik SK;
{Journal}: J Gastroenterol Hepatol
{Volume}: 39
{Issue}: 1
{Year}: 2024 Jan 11
{Factor}: 4.369
{DOI}: 10.1111/jgh.16327
{Abstract}: <B>OBJECTIVE: </B>Disorders of glucose metabolism, such as impaired glucose tolerance (IGT) and diabetes mellitus (DM), frequently occur in cirrhosis. We aimed to evaluate who needs to be undertaken a 75-g oral glucose tolerance test (OGTT) to find underlying subclinical diabetes.<BR><B>METHODS: </B>This prospective study included 713 patients with either compensated (Child-Turcotte-Pugh [CTP] class A) or decompensated cirrhosis (CTP class B/C) without previous DM history. All patients underwent a 75-g OGTT. The patients were divided into three groups: normal glucose tolerance (NGT), IGT, and newly diagnosed DM (subclinical DM).<BR><B>RESULTS: </B>Among 713 patients, NGT was diagnosed in 139 (19.5%), IGT in 252 (35.3%), and subclinical DM in 322 (45.2%) patients, respectively. During a median follow-up period of 42.0 months, the cumulative survival rates of patients were as follows: NGT, 75.6%; IGT, 57.6%; and subclinical DM, 54.8%. Overall, IGT (adjusted hazard ratio [aHR], 1.605; 95% confidence interval [CI] = 1.009-2.553; P = 0.046) and subclinical DM (aHR, 1.840; 95% CI = 1.183-2.861; P = 0.001) were identified as independent predictors of mortality. In patients with compensated cirrhosis (n = 415), neither IGT nor subclinical DM conferred a higher mortality risk. However, among patients with decompensated cirrhosis (n = 298), those with IGT (aHR, 2.394; P = 0.015) and subclinical DM (aHR, 2.211; P = 0.022) showed a survival rate worse than those with NGT. In addition, subclinical DM was identified as an independent risk factor for infection (aHR, 2.508; P = 0.007).<BR><B>CONCLUSIONS: </B>IGT and subclinical diabetes by OGTT are associated with an unfavorable prognosis in cirrhosis, and the effect is pronounced in the decompensated state.<BR><B>RESULTS: </B>gov, Number NCT04828512 (https://clinicaltrials.gov/ct2/show/NCT04828512).