To Correlate the Relation between Insulin Resistance and Serum Triglyceride Level in Euglycemic Cirrhotics

Abstract

BACKGROUND: Liver is the major site for carbohydrate, protein and lipid metabolism. Liver cirrhosis causes dearrangements in all functions of liver. It is quite common to get hypoglycemia due to impaired glycogen storage and gluconeogenesis in cirrhosis. At the same time it is not uncommon to get impaired glucose tolerance. The occurrence of insulin resistance in cirrhosis has definite clinical implications like rapid progression to fibrosis and increased risk of gastrointestinal haemorrhage and hepatocellular carcinoma OBJECTIVES: This study is done to establish the insulin resistance in euglycemic cirrhotics in South Indian population due to varied etiology and attempts to find the relation between triglycerides and insulin resistance. MATERIALS AND METHODS: The study was a cross sectional study of 50 subjects done in Government Royapettah Hospital. Patients were selected according to the inclusion criteria. A detailed history was taken and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Insulin resistance was assessed using HOMA1 IR, HOMA2 IR calculator and TyG index. RESULTS: The mean age of the population was 46.18± 9.78. Only three subjects included were females. Among the fifty subjects included, 34% had insulin resistance according to HOMA 1 IR (p 0.024) and 28% with HOMA2 IR (p 0.002). Insulin resistance using both HOMA 1 and 2 was significantly increased in Child Turcott Pugh C (p<0.001 for both). Only two had elevated serum triglycerides with majority less than 100 mg/dl. Insulin resistance was not demonstrated in any of subjects with TyG index. There was positive correlation between insulin resistance and fasting glucose and insulin. CONCLUSION: Insulin resistance is present in cirrhosis liver in euglycemics. This is increased with advancing disease. Serum triglyceride levels in these cirrhotics are not elevated and is not correlated with insulin resistance. It can be concluded that regular monitoring of glycemic status is mandatory in these patients which would have definite bearing upon treatment strategy