STUDY OF COMPARISON OF LIVER FUNCTION TESTS IN DIABETES CASES AND NON-DIABETICS CONTROLS.

less than 0.05 were considered significant. Results: the mean activity of serum bilirubin total (1.74 ± 0.897), bilirubin direct (0.474 ± 0.264), serum ast (62.56 ± 39.84 iu/l), serum alt (49.38 ± 45.85 u/l) and serum alp (134.32 ± 67.7 iu/l) of diabetic patients shows significant difference from that of normal subjects. Conclusion: the outcome of the present study shows that liver enzymes have higher activity in dm patients than controls. Thus screening for liver dysfunction in diabetics and subsequent workup may lead to early detection of hepatic co-morbidities and better management.


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Diabetes V/S LFT:-Type 2 diabetes (T2DM) is associated with a clinical spectrum of liver abnormalities collectively known as nonalcoholic fatty liver disease (NAFLD). NAFLD is a clinic histopathological diagnosis characterized by hepatocellular steatosis and ultimately cirrhosis. Serum alanine aminotransferase (ALT), which is a widely available serum marker of liver damage, is elevated in about 20% of children and adolescents with T2DM, and in most cases this is attributable to NAFLD. 3 Westerbacka J et al. 4 had demonstrated that ALT was closely associated with liver fat unlike Aspartate transaminase (AST) and gamma glutamyl transferase (GGT) and hence, ALT is used as a surrogate marker for many epidemiological studies. 5 Liver function tests (LFTs) are usually used in the clinical practice screen for liver disease; the tests include the serum aminotransferases, bilirubin, alkaline phosphatase albumin and prothrombin time. Aminotransferases such as Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) are measure the concentration of intracellular hepatocellular enzyme that have leaked into the circulation and serve as amarker of hepatocellular injury. Alkaline phosphatase (AP), γ-glutamyl transpeptidase (GGT), and bilirubin act as markers of biliary function and cholestasis. Albumin and prothrombin reflect liver synthetic function.
Individuals with type 2 diabetes have a higher incidence of liver function test abnormalities than individuals who do not have diabetes. Mild chronic elevations of transaminases often reflect underlying insulin resistance.
Pathophysiology:-Pathophysiological aspects of insulin resistance in NAFLD: role of lipids and energy metabolism 6 :-NAFLD is associated with hepatic and peripheral insulin resistance, resulting in an insufficient suppression of hepatic gluconeogenesis, decreased glycogen synthesis and increased lipid accumulation.
De novo synthesis of FFA is driven by sterol regulatory element binding-protein 1c (SREBP-1c) and carbohydrate response element binding-protein (ChREBP) and is catalysed by hyperinsulinaemia and hyperglycaemia .Whereas hepatic triglycerides stored in lipid droplets can be relatively inert or even protective, FFA might substantiate insulin resistance, causing lysosomal instability with leakage of cathepsin B and induction of the NF-κB−TNFα pathway, or by activating the caspase-1−IL-1β/IL-18 pathways through the NALP3 inflammasome. Diacylglycerol promotes insulin resistance through the activation of protein kinase C (PKC)ε and c-Jun N-terminal kinase (JNK).The hepatocyte attempts to limit FFA by increasing mitochondrial β-oxidation. 68 Statistical analysis:-Quantitative data was summarized in the form of MEAN ± SD and differences in means of both the groups were analyzed by unpaired student't' test using graph pad prism.P-value less than 0.05 were considered Significant.

Discussion and Conclusion:-
In our study, we found gross difference in serum bilirubin level (1.74 compare to 0.4 of controls P<0.05). Though the diabetic patient were hepatic asymptomatic.Like bilirubin level of two groups if we compare the ALT, AST and alkaline phosphatase levels of the two patients, the distributions of ALT, AST, and alkaline phosphatase show similar significant difference. In all samples the average levels were greater in 'diabetic' group. Altogether, our diabetic cases had at least one liver test abnormality, including mild transaminase elevation. But none of them had any symptoms of liver dysfunction. In our study, there has no significant difference among the distribution of total protein levels between the two groups of population. But the average albumin level in 'patients with diabetes' group is more than the 'healthy control' group (3.37 compared to 3.75; p>0.05). According to previously mentioned studies this difference is mainly due to higher average fasting and post prandial sugar level in diabetes.
The results of this study are in accordance with previously reported high prevalence rates of Altered Liver Enzymes in patients with type 2 diabetes mellitus in other populations. Raised ALT and AST are more common among the diabetes patients as compared to controls. Abnormal liver function tests among diabetes patients can be indicator of associated non alcoholic fatty liver disease. There has been a direct correlation between blood glucose and elevated liver enzymes, in accordance with previous studies. Checking for liver enzymes, ALT and AST should be carried out to screen the possibility of underlying fatty liver, which might need further evaluation and early intervention to prevent from progression into cirrhosis and chronic liver disease, especially in patients with Diabetes & high BMI. Although there are currently no consensus guidelines or recommendations regarding LFT screening in patients with type 2 diabetes mellitus, these findings lend support to the practice of routine liver function monitoring in subjects with type 2 diabetes mellitus.
Therefore, if LFT screening is to be adopted, it would be incumbent on the physician to ensure that abnormal findings are appropriately investigated, or that the patient be timorously referred to a tertiary institution with the necessary facilities.