A Study of Hepatogenous Diabetes among Decompensated Chronic Liver Disease in a Tertiary Care Hospital of Tripura- A Cross-sectional Study

Introduction: Hepatogenous Diabetes is a state of impaired glucose regulation caused by consequences of Liver Cirrhosis. Hepatogenous Diabetes (HD) is increases common complications of liver cirrhosis like Hepatic Encephalopathy, UGI bleeding, spontaneous peritonitis, ascites etc. Liver being a vital organ related to Glucose metabolism, Liver disease effects glucose metabolism due to several changes occurring in Chronic Liver Disease (CLD). There is a strong association between CLD and Diabetes risk & they co-exists too increasing the common complications.  The management of diabetes in cirrhotic patients is also challenging because of physio‑pathological changes in cirrhosis & altered pharmacokinetics of drugs used increasing the adverse events. Only few studies on Hepatogenous Diabetes has been done in India & it is the first study on this disease among population of Tripura. With this view, this Study was planned to estimate proportion of Hepatogenous Diabetes among patients of Decompensated Chronic Liver Disease in Tripura & determine any relation between various etiological factors with Hepatogenous Diabetes. Methodology: It is a Cross-sectional Study conducted by the Department of Biochemistry in collaboration with the Department of General Medicine at AGMC & GBP Hospital. Sample size was calculated as 190 by using the standard formula. 190 samples were collected by Random Sampling method.  Results: Prevalence of Hepatogenous Diabetes among decompensated chronic liver disease is found to be 15.3 % & 84.7 % were CLD without HD. Among 190 samples analysed in this study, 76.3% were Male & 23.7% were Female. Among Hepatogenous Diabetes (HD) 89.7% were Male & 10.3% were Female & among Chronic Liver Disease (CLD) without Hepatogenous Diabetes (HD), 73.9 % were Male & 26.1% were Female. In study population 54.7% were having Alcoholic Liver Disease (ALD), 13.2% Non Alcoholic Fatty Liver Disease (NAFLD), 19.4% Hepatitis B Virus (HBV), 11.1% Hepatitis C Virus (HCV) & 1.6% both HBV&HCV. In Hepatogenous Diabetes & CLD without HD population, most cases were Alcoholic Liver Disease (ALD) i.e. 65.5% & 52.8% respectively. In Receiver Operating Characteristic Analysis or ROC Analysis is done among the different Biochemical parameters for the Hepatogenous Diabetes 2HrPG is having highest Area Under Curve (AUC) followed by HbA1c, FPG. Among the Liver Profile Test parameters Direct Bilirubin having highest AUC, followed by ALP & AST & lowest AUC for Total Protein & Albumin. 2HrPG is expected to be the most efficient parameter among these to diagnose Hepatogenous Diabetes in this study. 2Hr PG shows Positive Correlation with FPG & HbA1c with p value <0.001 & showing Negative Correlation with Total & Indirect Bilirubin, AST, ALT, Tot. Protein, Albumin, Globulin & A/G ratio but not significant. HbA1c shows Positive Correlation with FPG & 2HrPG with p value <0.001, Positive Correlation with ALP with p value <0.05 & Negative Correlation with Albumin with p value <0.05. Conclusion: Prevalence of Hepatogenous Diabetes among decompensated chronic liver disease in this study is 15.3 %. This study is the first study on Hepatogenous Diabetes in Tripura. Studies on Hepatogenous Diabetes are done in very few & not done properly yet. This study will help in understanding the pathophysiology & dynamics of the disease; ultimately aiding to the better patient care