Prevalence of Glucose Metabolism Disorder in Liver Cirrhosis and its Correlation with Risk Factors of Diabetes Mellitus: A Hospital-Based Cross Sectional Observational Study from New Delhi

Objectives: Association between liver cirrhosis (LC) and glucose intolerance has been known since long. This study was carried out to (1) determine the proportion of LC patients having insulin resistance and glucose metabolism disorder (GMD) which includes pre-diabetes (pre-DM) and diabetes mellitus (DM) and (2) study the correlation between GMD and the presence of risk factors (RF) for DM in patients with LC. Methods: 100 patients with LC admitted in medical wards were studied and tested with fasting plasma glucose (FPG), 2 hours post-75 gram oral glucose load plasma glucose (PPG), glycosylated hemoglobin (HbA1c) and fasting plasma insulin. They were also evaluated for the presence or absence of RF for DM and groups of LC patients with and without GMD were compared. Results: Out of the 100 patients, 77% were males and 76% were between 30-59 years of age. Insulin resistance (IR) was found in 26% and GMD in 39% (pre-DM 13% & DM 26%). Certain RF for DM like advanced age, positive family history (F/H) of DM, high body mass index (BMI), hypertension, high triglycerides, history of CAD/ CVA/ PVD showed positive correlation with the occurrence of GMD in LC; advanced age, hypertension and high triglycerides had a significant correlation with occurrence of IR. Conclusion: GMD was prevalent in about a third and IR in about a quarter of patients with LC. Traditional risk factors of DM increase the chances of an individual with LC having GMD. IR increased with advanced age, the presence of hypertension and high triglycerides and did not always predate GMD.

A comparative study of the clinico-aetiological profile of hyponatremia at presentation with that developing in the hospital

Background & objectives: Hyponatremia is a common problem encountered in patients presenting with nonspecific symptoms. We undertook this study to investigate the clinical profile of patients with hyponatremia, the precipitating factors, the response to therapy and to compare, using these parameters, hyponatremia at presentation to that developing in the hospital. Methods: Seventy consecutive patients with serum sodium less than or equal to 125 mmol/l at presentation or at any time during hospital admission were identified and studied using a proforma. The severity of hyponatremia, therapy given and time taken for recovery were analysed. Results: The mean age of patients was 48.1 ± 16.1 yr. The mean serum sodium was 117.8 ± 6.4 mmol/l. Confusion, headache and malaise were the most common symptoms, two patients had seizures, and 20.0 per cent patients showed no clinical manifestations. Nausea was significantly (P<0.05) more common in patients presenting with hyponatremia. 22 patients (31.4%) developed hyponatremia during their stay in the hospital. 3 patients (4.3%) presented with hyponatremia which got worse during the admission period. Most had multiple precipitating factors, decreased intake being the most common (82.9%), followed by increased losses (65.7%) and miscellaneous factors (70.0%). Drugs, fluid overload and inappropriate Ryle's tube feeds more commonly precipitated hyponatremia in in-hospital patients. Time taken for recovery showed negative correlation with the serum sodium. Patients with in-hospital hyponatremia took significantly longer time to recover (P<0.05). Interpretation & conclusions: Decreased intake was found to be the commonest cause of hyponatremia, thus, ensuring adequate oral intake, especially in patients on liquid diet and in manual labourers, and correction of hyponatremia as soon as an abnormality is detected is important.

Can protein carbonyl / glutathione ratio be used as a potential biomarker to assess oxidative stress in alcoholic hepatitis.

Context: Oxidative stress plays a crucial role in the pathogenesis of alcoholic liver disease (ALD). Aim: The present study was undertaken to evaluate the significance of protein carbonyl / glutathione ratio as a biomarker to assess the oxidative stress in alcoholic hepatitis. Settings and Design: The study included 30 patients with alcoholic hepatitis and 30 age-sex- matched controls. Protein carbonyl (PCO) levels was estimated by modified levine's method, malondialdehyde (MDA) by thiobarbituric acid method, reduced glutathione (GSH) by dithiobis-2-nitrobenzoic acid method, total sialic acid (TSA) by modified aminoff's method, plasma transferases (GGT, AST, and ALT), total protein and albumin using commercial kits adapted to autoanalyzer respectively. Statistical Analysis Used: All data were expressed as mean ± SEM. Spearman's correlation analysis and receiver operating characteristic curve were performed using SPSS version 16 for Microsoft. A P value < 0.05 was considered as significant. Results: Alcoholic hepatitis patients showed significantly higher levels of PCO, MDA, GGT, AST, AST/ALT, TSA, and significantly lower GSH, total protein and albumin levels. PCO/GSH ratio in these patients showed a significant positive correlation with GGT (r = 0.594, P = 0.000), AST/ALT (r = 0.443 P = 0.000), MDA (r = 0.727, P = 0.000), TSA (r = 0.729, P = 0.000), and a significant negative correlation with total protein (r = -0.683, P = 0.000) and albumin (r = -0.544, P = 0.000). ROC curve showed a cut off value of 2.735, indicating 100% sensitivity and 90% specificity of PCO/GSH at this value. Conclusions: Alcohol intake regularly for long duration leads to oxidative stress. We suggest that PCO/GSH ratio can be used as a potential biomarker to assess oxidative stress in alcoholic hepatitis.

rotein glycation, insulin sensitivity and pancreatic beta cell function in high-risk, non-diabetic, first degree relatives of patients with type 2 diabetes.

Insulin resistance and impaired beta cell function are widely recognized as features of type 2 diabetes. But it is still debated whether insulin resistance or beta cell dysfunction constitutes the primary abnormality. This study was done to evaluate the impact of family history of type 2 diabetes on insulin resistance, beta cell function and glycation of proteins. A total of 30 healthy subjects with a positive family history of type 2 diabetes and thirty two healthy age-matched subjects without any family history of type 2 diabetes were enrolled in this study. Fasting glucose, post prandial glucose, fasting plasma insulin, fructosamine and glycated hemoglobin were evaluated in both the study groups. The mean fasting glucose, fasting Insulin and HOMA-IR were significantly higher among the first-degree relatives of type 2 diabetics, but there was no alteration in HOMA-B. The levels of both glycated hemoglobin and fructosamine were significantly increased in the test group when compared with controls. In conclusion the results from the present study suggest that Indian subjects with family history of type 2 diabetes are associated with insulin resistance and enhanced glycation of proteins, but with no evidence of beta cell defect.

Altered oxidant-antioxidant status in non-obese men with moderate essential hypertension.

BACKGROUND: Although a wide number of experimental evidences are available regarding oxidant-antioxidant disturbance in hypertension, clinical data supporting it is lacking in men in early stages of hypertension. AIMS: The objective of the study was to evaluate oxidative status and antioxidant activities in males with stage I essential hypertension. MATERIALS AND METHODS: Thirty hypertensives and 21 normotensives were included in the study. Protein carbonyl, reduced glutathione, glutathione peroxidase, catalase and fasting glucose were assessed in both the groups. STATISTICAL ANALYSIS: Results were analyzed by student's 't' test and linear regression analysis test. RESULTS: Plasma protein carbonyl and glutathione peroxidase were significantly increased and catalase and GSH were significantly reduced in the hypertensive group compared to normotensive subjects. There was a significant negative correlation between glutathione peroxidase and catalase in the test group. CONCLUSIONS: The data from the present study indicates an alteration in oxidant-antioxidant status in non-obese men in early stages of essential hypertension.