https://imcjms.com Ibrahim Medical College Journal of Medical Science https://imcjms.com/registration/journal_full_text/225 Sun, 04 Jun 2017 13:14:26 +0000 Diabetes mellitus is being recognized as a serious global health problem and frequently associated with cirrhosis of liver. The cross-sectional comparative study was conducted among 83 diabetic cirrhotic patients admitted in Gastrointestinal Hepatobilliary and Pancreatic Disorders Department of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic disorders and 83 non-diabetic cirrhotic patients admitted in Gastroenterology and Hepatology Department of Bangabandhu Sheikh Mujibar Medical University, Dhaka to assess the relationship between cirrhosis of liver and diabetes mellitus. The study was carried out during the period of January to June, 2010 and data were collected through face to face interview and reviewing medical documents by using a semi-structured questionnaire and checklist. Male, Muslims and illiterate were predominant in both diabetic and non-diabetic cirrhotic patients. It was found that non-viral cirrhosis was much higher in older age group (51-60years) than in younger age group (41-50years) in comparison to viral cirrhosis and this difference was found statistically significant [χ2(3)=20.97, p<0.001]. Association of non-viral cirrhosis was found with hyperglycemia [χ2(1)=15.65, p<0.001], poor glycaemic control [χ2(1)= 9.86, p<0.01] and longer duration of diabetes [χ2(2) =9.51, p<0.01]. Non-viral cirrhosis was significantly higher (28.3%) among the diabetic patients than the non-diabetic patients who suffered more (28.3%) from viral [χ2(1)=41.36, p<.001]. The study recommends for glycemic control by leading disciplined life and taking apposite therapy for prevention of non-viral cirrhosis among diabetic patients. Address for Correspondence:Dr. Smita Debsarma, Lecturer, Department of Community Medicine, Ibrahim Medical College, 122 Kazi Nazrul Islam Avenue, Shahbagh, Dhaka 1000   The increasing prevalence of non-communicable diseases is a serious challenge, where the success in extending life expectancy is translated into a real threat to global health.1 Non-communicable diseases are responsible for 60% of all deaths, 80% of these deaths are in low- and middle-income countries.2 In 2000, Bangladesh had 3.2 million people with diabetes and was listed at 10, which will occupy the 7th position with 11.1 million in 2030.3 The prevalence of type 2 diabetes observed in Bangladesh was 5.2 (rural 4.3%, urban 6.9%) at 1994-5 and 11.2% (urban) and 6.8% (rural) at 2003-4.4 Prevalence of diabetes is just double in urban areas due to unplanned urbanization and change in lifestyle.5 Nonalcoholic steatohepatitis (NASH) is an under-recognized cause of cryptogenic cirrhosis (CC) on the basis of higher prevalence of obesity and type II diabetes.10 NAFLD is observed principally in developed countries where sedentary lifestyle and high calorie, sugar, and fat diets lead to DM2 and obesity. Individuals with type-2 diabetes have a high (70.0%) prevalence of NAFLD, and seem to have an increased severity of disease. Prevalence of NAFLD is higher (20.0%) than that of NASH (3.0%) in developed countries and prevalence of each is presumably much higher among obese and diabetic persons because 55.0% of patients with NASH have DM2 and 95.0% are obese.11   The cross-sectional comparative study was conducted among 83 diabetic cirrhotic patients and 83 non-diabetic cirrhotic patients who were admitted in Bangladesh Institute of Research and Rehabilitation in Diabetes and Hepatology Department of Bangabandhu Sheikh Mujibar Medical University, Dhaka respectively. The study was carried out over the period of 6 months from January to June 2010. Both diabetic and non-diabetic cirrhotic patients were included conveniently irrespective of age and sex and obtaining informed written consent. Viral and non-viral cirrhotic patients were diagnosed by viral markers and USG of whole abdomen. HbA1C, fasting blood glucose and 2 hrs after breakfast were done to see glycemic control and blood glucose level of the diabetes patients.   Mean age for diabetic patients was 56.93 (±11.68) years while mean age for the non-diabetic patients was 46.19 (±13.85) years. Among diabetic patients, majority were in the older age group (51-60 years) while majority of the non-diabetic patients were in the productive age group (<40years). Male, Muslim and married were predominant in both the groups. [Table-1] Table-1: Socio-demographic variables between diabetic and non-diabetic patients     Mean age for developing viral cirrhosis was lower (48.75 ±13.01 years) than the mean age for developing non-viral cirrhosis (57.24±13.89 years). Majority (32.4%) of the cirrhotic patients of viral origin were in the age group of 41-50 years while majority (41.8%) of the cirrhotic patients of non-viral origin were in the age group of 51-60 years and this difference was found statistically significant [χ2(3)=20.97, p<.001]. Both viral and non-viral cirrhosis were significantly higher among married patients [χ2 (1) =7.133, p<.05]. Though both viral (66.7%) and non-viral (61.8%)cirrhosis were predominant among the males than their counterpart females but this sex differential was not statistically significant [χ2(1)=0.38, p=0.54]. Non-viral cirrhosis was significantly higher among the patients with hyperglycemia (76.6%) [χ2(1)=15.65, p<.001], poor glycaemic control (59.6%) [χ2(1)= 9.86, p<.01] and longer duration of diabetes (83.0%) [χ2(2)=9.51, p<.01]. [Table-4] Among the diabetics, majority (28.3%) patients had non-viral cirrhosis while 21.7% had viral cirrhosis while majority (45.2%) of the non-diabetes patients had viral cirrhosis and only 4.8% had non-viral cirrhosis and this difference was statistically significant [χ2(1)=41.36, p< .001]. Table-3: Distribution of socio-demographic variables by cirrhosis of liver   Table-5: Relationship between diabetes mellitus and cirrhosis of liver   The cross sectional comparative study was aimed to assess the relationship between cirrhosis of liver and diabetes mellitus and to find out the underlying causes of cirrhosis of liver among 83 diabetes and 83 non-diabetes patients. The current study estimated 51.2% HBV and 15.7% HCV infections among diabetes patients. Previously reported by Pazhanivel M and Jayanthi V diverse findings where HBV infection was18.38% and HCV infection was 6.01% among DM patients.15 This variation may be due to unawareness and transfusion of unscreened blood and blood products in our country. It was also found that majority (28.3%) diabetes patients had non-viral cirrhosis while majority (45.2%) of the non-diabetes patients had viral cirrhosis and this difference was found statistically significant [χ2(1)=41.36, p<.001]. But the study conducted by Amarapurkar D found majority of both diabetic (34.9%) and non-diabetic (28.2%) had non-viral cirrhosis.16 Conclusion   References 2.   Preventing chronic diseases; A vital Investment. WHO 2010. Available from: http://www.who.int/chp/chronic_disease_report/overview. 4.   Mahtab H, Latif ZA, Pathan F. Diabetes Mellitus- a handbook for professionals. Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) 2007; 4: 24-29. 6.   Cirrhosis of Liver, 2010. Available from: http://www.digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis. 8.   Ingrid J. Hickman, Graeme A. Macdonald. Impact of Diabetes on the Severity of Liver Disease. The American Journal of Medicine 2007; 120: 829-834. 10.Poonawala A, Nair SP, Thuluvath PJ. Prevalence of obesity and diabetes in patients with cryptogenic cirrhosis: A case control study. Hepatology 2000; 32(4): 689-692. 12.World Health Organization. Issues and challenges in the prevention and control of Non-communicable diseases in South East Asia Region. WHO regional office South East Asia, Delhi, India, 2009. 14.Bangladesh Bureau of Statistics. Statistical Pocket book of Bangladesh 2008. Dhaka: Planning Division, Ministry of Planning, Government of the People’s Republic of Bangladesh 2009; 2, 6,10, 38. 16.Amarapurkar D, Das HS. Chronic liver disease in diabetes mellitus. Trop Gastroenterol 2002; 23(1): 3-5. 2026 Ibrahim Medical College. All rights reserved.