Abbas TA and Razavian NZ
Background: A growing body of evidence would consider the cryptogenic cirrhosis as the immediate offspring of Type 2 diabetes mellitus (T2DM). But, what we routinely observe here in Iran seems totally different. We would suggest that, the majority of reported cases of cryptogenic cirrhosis are actually the result of surreptitious or under-estimated alcohol consumption in a subject suffering from metabolic syndrome, not the direct consequence or as a blooming belief, a chronic complication of T2DM. In order to clarify the issue, a population of T2DM subjects living in a closed, religious society in which alcohol production, distribution, and consumption were legally and also ritually controlled, were investigated for manifestations of end-stage liver disease.
Materials and methods: In a prospective observational study, one hundred and thirty-two T2DM subjects (43 males and 89 females) were consecutively included. They were interviewed and carefully examined for any stigmata of chronic liver failure and cirrhosis. Then, a comprehensive set of liver function tests not to mention viral and immunological markers and also abdominal sonography were carried out. Liver biopsy was considered once academically indicated.
Results: The average age of patients was 58 ± 10.9 years (range, 31-83 years), and the duration of diabetes was 7.4 ± 6 years (range, 1-25 years). BMI came out as 34.9 ± 5.3 with mean waist circumference of 71.2 ± 11.5 cm. To our surprise, from 132 T2DM patients only eight cases (6%) displayed mild to moderate abnormal liver enzymes level, of which only 2 cases had liver enzymes more than twice normal. With regard to our main concern, only two subjects (1.5%) manifested overt liver failure and cirrhosis, of whom, one person tested positive for HCVAb and the other disclosed eventually to have been drinking alcohol at younger ages for years while living abroad.
Conclusion: We would suggest, if alcoholic liver disease -as a major confounding variable- becomes efficiently eliminated from the relevant studies, T2DM, per se, would seldom persist as a direct causative risk for cryptogenic cirrhosis. We, as a matter of quite conceivable fact, believe that T2DM, NAFLD and cryptogenic cirrhosis are all the results of a superior pathogenic process, the metabolic syndrome or better to say insulin resistance syndrome.
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