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Article Type

Original Study

Abstract

Objective This study was designed to determine the role of diabetes mellitus (DM) in the pathogenesis of hepatic encephalopathy (HE) in patients with liver cirrhosis. Background DM and its complications may play a role in the mortality of hepatitis C virus (HCV)-related cirrhotic patients. DM is considered a comorbid disease in these patients and strict control of blood glucose level could improve survival in HCV-related cirrhosis. Patients and methods This study was carried out on 100 cirrhotic patients with DM [50 encephalopathic patients (group I) and 50 nonencephalopathic patients (group II)]. All patients in the study were subjected to a thorough assessment of history taking and thorough physical examination, laboratory investigations, including complete blood picture, liver function tests, liver, viral HBsAg and HCVAb, kidney function tests, serum sodium and potassium levels, abdominal ultrasonography, serum ammonia level, fasting and postprandial blood sugar levels, glycosylated hemoglobin (HbA1c) as well as tests to detect the presence of autonomic neuropathy (tilt-table test and diurnal variation of blood pressure measurements). Results The present study found a significant positive tilt-table test result and diurnal variation in blood pressure measurements in the encephalopathic group in comparison with the nonencephalopathic group, and a highly significant positive correlation between duration of DM and HbA1c levels when compared with grades of HE in the encephalopathic group. Conclusion Cirrhotic patients with longstanding and uncontrolled DM are more likely to have higher grades of HE. Autonomic neuropathy, which may complicate cirrhotic patients with longstanding uncontrolled diabetes, may play a role in the pathogenesis of HE in these patients.

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