A clinical analysis of hypoglycemia in patients with liver cirrhosis and diabetes mellitus

Objective To investigate the causes of hypoglycemia and the features of clinical indices in patients with liver cirrhosis and diabetes mellitus. Methods A total of 50 patients with liver cirrhosis and diabetes mellitus who were admitted to Beijing YouAn Hospital,Capital Medical University,from January 2017 to June 2019 were enrolled as subjects,among whom 25 patients with one hypoglycemic event were enrolled as experimental group and 25 patients without hypoglycemia were enrolled as control group. Hepatic and renal function,fasting blood glucose,glycosylated hemoglobin,and Child-Pugh class were evaluated for both groups,and the time period and possible causes of hypoglycemia were analyzed. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results Compared with the control group,the experimental group had significantly lower levels of fasting blood glucose [6. 10( 3. 45 ～ 8. 96) mmol/L vs 8. 12( 6. 18 ～12. 59) mmol/L,Z =-2. 687,P = 0. 007],cholinesterase [3009. 00( 1788. 50 ～ 4439. 50) U/L vs 4936. 00( 4051. 00 ～ 6740. 50) U/L,Z =-3. 095,P = 0. 002),albumin( 32. 02 ± 7. 07 g/L vs 35. 89 ± 5. 49 g/L,t = 2. 161,P = 0. 036),and glycosylated hemoglobin( 6. 97± 1. 64 mmol/L vs 8. 04 ± 1. 78 mmol/L,t = 2. 047,P = 0. 047). Among the patients in the experimental group,36% had Child-Pugh class B cirrhosis and 36% had Child-Pugh class C cirrhosis,and among the patients in the control group,56% had Child-Pugh class A cirrhosis and 40% had Child-Pugh class B cirrhosis; there was a significant difference in Child-Pugh class between the two groups( χ2=8. 786,P = 0. 012). Most of the patients with liver cirrhosis and diabetes mellitus experienced hypoglycemia in the fasting state in the morning and in the daytime,with the main causes of excessive insulin( 44%) and insufficient food intake or calorie supplementation( 40%),and some patients experienced fasting asymptomatic hypoglycemia( 16%). Conclusion Blood glucose monitoring and management should be taken seriously for patients with liver cirrhosis and diabetes mellitus in clinical practice,in order to reduce the occurrence of hypoglycemia.