Table of ContentsView AllTable of ContentsHow They Are LinkedRisk FactorsTreatmentPreventionFAQs
Table of ContentsView All
View All
Table of Contents
How They Are Linked
Risk Factors
Treatment
Prevention
FAQs
There is a close association betweendiabetesandliver disease. In some cases, diabetes can cause progressive liver scarring, leading to a liver injury known ascirrhosis. Diabetes can also speed the progression of liver disease, increasing the risk of severe and potentially life-threatening complications like liver failure or liver cancer.
In addition, there is evidence that having a liver disease can contribute to the onset of diabetes.
Studies suggest that anywhere from 30% to 40% of people with liver cirrhosis in the United States have diabetes and that having diabetes independently increases the risk of complications and death from liver disease.
This article takes an in-depth look at the connection between diabetes and liver disease, including how one may increase the risk of the other. It also explores the various treatment options and what you can do to reduce the risk of liver disease if you are living with diabetes.
FatCamera / Getty Images
Connection Between Diabetes and Liver Disease
Diabetes is a group of diseases that occurs either when thepancreasdoes not produce enoughinsulin—the hormone that regulates bloodglucose(sugar)—or the body cannot effectively use the insulin it produces. This can lead to a condition known ashyperglycemia(high blood sugar)
If left unchecked, persistently high blood glucose levels can severely damage nerves, blood vessels, tissues, and organs throughout the body.
The liver is one of the organs vulnerable to these effects. Over time, the damage caused to the liver can reduce its ability to filter toxins from the blood or maintain healthy blood sugar levels, resulting in chronic liver disease (CLD). With CLD, the damage caused to the liver is largely irreversible.
There is also a cause-and-effect relationship between diabetes and liver disease in that CLD can also play a role in the development oftype 2 diabetes(the form of diabetes largely related to lifestyle factors like diet and obesity).
What Is the Function of the Liver?
How Diabetes Causes Liver Disease
When diabetes is poorly controlled, the impact of hyperglycemia on the liver can be profound. The liver is especially vulnerable, in part because it both stores and manufactures glucose depending upon the body’s needs.
When blood sugar levels are high, free radicals can exceed antioxidant levels and start to inflict damage on cells, referred to as oxidative stress. Oxidative stress, in turn, triggersinflammationwhich can cause changes to the liver over time.
The liver is susceptible to the damaging effects of diabetes because it is tasked with warehousing sugar in the body.As such, higher levels of blood sugar translate to higher levels of free radicals, which causes higher levels of oxidative stress.
Some people with diabetes-induced liver disease may only progress to a certain stage and no further, while others may progress to end-stage disease. People with poorly controlled or untreated diabetes are at the greatest risk of progression.
Cause and Risk Factors of Liver Disease
How Liver Disease Causes Diabetes
Over time, however, insulin resistance can start to “wear out” pancreatic cells to where they can no longer produce enough insulin to compensate for this effect. The result is higher blood sugar levels and, ultimately,prediabetesor type 2 diabetes.
Cause or Effect?While diabetes typically precedes the onset of liver disease, some studies suggest that liver disease will precede type 2 diabetes in roughly 15% to 20% of cases. The majority of these cases involves people with decompensated cirrhosis who have never had diabetes before.
Cause or Effect?
While diabetes typically precedes the onset of liver disease, some studies suggest that liver disease will precede type 2 diabetes in roughly 15% to 20% of cases. The majority of these cases involves people with decompensated cirrhosis who have never had diabetes before.
Complications of Untreated Diabetes
Risks
Diabetes and CLD are bothchronic diseases, meaning that they are persistent and typically progressive. If left untreated, diabetes can increase the risk of liver disease, and liver disease can increase the risk of diabetes. The risk ofcomorbidity(the simultaneous occurrence of two diseases) is greater if diabetes or CLD is advanced.
Risk factors are associated with the progression of both diseases, some of which overlap.
Risk FactorsType 2 DiabetesOver age 45Having obesitySmokingPhysical inactivityFamily history of diabetesHaving MASLDChronic Liver DiseaseOver age 60Having obesitySmokingExcessive alcohol useHepatitis B or CHaving type 2 diabetes
Type 2 DiabetesOver age 45Having obesitySmokingPhysical inactivityFamily history of diabetesHaving MASLD
Over age 45
Having obesity
Smoking
Physical inactivity
Family history of diabetes
Having MASLD
Chronic Liver DiseaseOver age 60Having obesitySmokingExcessive alcohol useHepatitis B or CHaving type 2 diabetes
Over age 60
Excessive alcohol use
Hepatitis B or C
Having type 2 diabetes
Treatment and Management of Diabetes and Liver Disease
While there is no cure for either diabetes or chronic liver disease, both can be managed with lifestyle changes and medications. These interventions can help slow disease progression and prevent long-term complications involving not only the liver but theheartandkidneysas well.
It is well known that basic lifestyle changes—such as increased exercise, a healthy diet, smoking cessation, and alcohol avoidance—are fundamental to the management of diabetes and liver disease.
When diabetes and liver disease occur together, medications are commonly prescribed to maintain better blood sugar control. This helps reduce oxidative stress and further damage to the liver.
Goals of TherapyThe goal of diabetes treatment for people with liver disease is the same as for anyone with diabetes, namely to maintain ahemoglobin A1Clevel below 7%. The A1C test measures your average blood sugar levels over the past three months.
Goals of Therapy
The goal of diabetes treatment for people with liver disease is the same as for anyone with diabetes, namely to maintain ahemoglobin A1Clevel below 7%. The A1C test measures your average blood sugar levels over the past three months.
The choice of drug can vary based on the stage and severity of your condition. Each has its benefits and risks and may be used either in combination or on its own.
If cirrhosis is involved, the main treatments are cutting salt from your diet and taking diuretics (“water pills”) like Aldactone (spironolactone) or Lasix (furosemide) to prevent the buildup of fluid in the abdomen (calledascites). In severe cases, you may need to have the fluid drained from your belly with a tube.
In cases of liver cancer, treatment options includeradiation therapy,ablation therapy(placing a probe or needle into the tumor to kill the cells),targeted therapy(drugs that interfere with substances needed for cancer to grow),immunotherapy(treatment that uses the immune system or products of the immune system to fight cancer),resection surgery, orliver transplant.
How Type 2 Diabetes Is Treated
With that said, many of the causes of type 2 diabetes and CLD are well-known and can be avoided with certain preventive strategies.
Types 2 DiabetesMaintain a healthy weight.Exercise regularly.Eat a healthier diet with less saturated fats and sugar.Stop smoking.Chronic Liver DiseaseMaintain a healthy weight.Exercise regularly.Eat a healthier diet with less saturated fats.Reduce your alcohol intake.Get vaccinated for hepatitis B.Use condoms during sex to avoid hepatitis B.Avoid sharing needles to avoid hepatitis B and C.
Types 2 DiabetesMaintain a healthy weight.Exercise regularly.Eat a healthier diet with less saturated fats and sugar.Stop smoking.
Maintain a healthy weight.
Exercise regularly.
Eat a healthier diet with less saturated fats and sugar.
Stop smoking.
Chronic Liver DiseaseMaintain a healthy weight.Exercise regularly.Eat a healthier diet with less saturated fats.Reduce your alcohol intake.Get vaccinated for hepatitis B.Use condoms during sex to avoid hepatitis B.Avoid sharing needles to avoid hepatitis B and C.
Eat a healthier diet with less saturated fats.
Reduce your alcohol intake.
Get vaccinated for hepatitis B.
Use condoms during sex to avoid hepatitis B.
Avoid sharing needles to avoid hepatitis B and C.
Summary
Diabetes and chronic liver disease (CLD) are closely linked. On the one hand, uncontrolled diabetes can cause changes to the liver that can lead to metabolic dysfunction-associated steatotic liver disease (MASLD), cirrhosis, and liver cancer. On the other, CLD can make liver cells less sensitive to insulin and contribute to the onset of type 2 diabetes. It can be difficult to know which is the cause and which is the effect.
People with diabetes and CLD are treated with a combination of lifestyle changes and medications to better manage blood sugar levels. Managing diabetes places less stress on the liver, preserving its function and slowing disease progression.
A Word From Verywell
One of the challenges of diabetes and chronic liver disease is that both are often asymptomatic (without symptoms), particularly in the early stages. This is especially true for people with CLD. Less than 2% of whom are diagnosed, according to the Centers for Disease Control and Prevention (CDC).
To this end, it is important to know and recognize the early signs of liver disease—including fatigue, nausea or vomiting, dark urine, pale stools, andjaundice(yellowing of the eyes or skin)—and report them to your healthcare provider immediately so that you can seek treatment and avoid long-term health complications.
How to Choose the Right Liver Specialist
Frequently Asked Questions
Learn MoreCan I Drink If I Have Cirrhosis?
Maybe. If you have diabetes, the risk of metabolic dysfunction-associated steatotic liver disease (MASLD) is 2 to 3 times greater than that of the general population. Studies suggest that between 50% and 70% of people with diabetes have MASLD compared to 25% of people without diabetes.
Learn MoreLiver Cancer Risk Factors
28 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chung W, Promrat K, Wands J.Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases.World J Hepatol.2020;12(9):533–557. doi:10.4254/wjh.v12.i9.533Loria P, Lonardo A, Anania F.Liver and diabetes. A vicious circle.Hepatol Res. 2013:43(1):51–64. doi:10.1111/j.1872-034X.2012.01031.xGarcia-Compean D, Orsi E, Kumar R, et al.Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.World J Gastroenterol.2022;28(8):775–793. doi:10.3748/wjg.v28.i8.775Banday MZ, Sameer AS, Nissar S.Pathophysiology of diabetes: An overview.Avicenna J Med.2020;10(4):174–188. doi:10.4103/ajm.ajm_53_20Mohamed J, Nazratun Nafizah AH, Zariyantey Ah, Budin SB.Mechanisms of diabetes-induced liver damage: the role of oxidative stress and inflammation.Sultan Qaboos Univ Med J.2016;16(2):e132–e141. doi:10.18295/squmj.2016.16.02.002Yang JD, Ahmed F, Mara KC, et al.Diabetes is associated with increased risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease.Hepatology. 2020;71(3):907–916. doi:10.1002/hep.30858Kumar R.Hepatogenous diabetes: An underestimated problem of liver cirrhosis.Indian J Endocrinol Metab.2018;22(4):552–559. doi:10.4103/ijem.IJEM_79_18National Institute of Diabetes and Digestive and Kidney Diseases.Insulin resistance and prediabetes.Orsi E, Grancini V, Menini S, Aghemo A, Puglieses G.Hepatogenous diabetes: Is it time to separate it from type 2 diabetes?Liver Int. 2017;37(7):950-962. doi:10.1111/liv.13337Lee YH, Cho Y, Lee BW, et al.Nonalcoholic fatty liver disease in diabetes. Part I: epidemiology and diagnosis.Diabetes Metab J.2019;43(1):31–45. doi:10.4093/dmj.2019.0011Akmal k, Hassabo H, Botrus G, et al.Impact of metformin on HCC prognosis.Cancer Res.2012;72 (8_Supplement):3594. doi:10.1158/1538-7445.AM2012-3594Ly Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne).2020;11:191. doi:10.3389/fendo.2020.00191Sumida Y, Yoneda M, Tokushige K, et al.Antidiabetic therapy in the treatment of nonalcoholic steatohepatitis.Int J Mol Sci.2020;21(6):1907. doi:10.3390/ijms21061907Cusi K, Orsak B, Bril F, et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: A randomized trial.Ann Intern Med. 2016;165(5):305-15. doi:10.7326/M15-1774National Institute of Diabetes and Digestive and Kidney Diseases.Alpha-glucosidase inhibitors.Seghieri M, Christensen AS, Andersen A, Solini A, Knop FK, Vilsboll T.Future perspectives on GLP-1 receptor agonists and GLP-1/glucagon receptor co-agonists in the treatment of NAFLD.Front Endocrinol (Lausanne).2018;9L649. doi:10.3389/fendo.2018.00649Hsu WH, Sue SP, Liang HL, et al.Dipeptidyl deptidase 4 inhibitors decrease the risk of hepatocellular carcinoma in patients with dhronic hepatitis C infection and type 2 diabetes mellitus: A nationwide study in Taiwan.Front Public Health. 2021;9:711723. doi:10.3389/fpubh.2021.711723Yen FS, Wei JCC, Yip HT, HWu CM, Hou MC, Hsu CC.Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: A nationwide population-based cohort study in Taiwan.Hepatol Int. 2021;15(1):179-90. doi:10.1007/s12072-020-10122-1Yang H, Choi E, Park E, et al.Risk of genital and urinary tract infections associated with SGLT‐2 inhibitors as an add‐on therapy to metformin in patients with type 2 diabetes mellitus: A retrospective cohort study in Korea.Pharmacol Res Perspect.2022;10(1):e00910. doi:10.1002/prp2.910Sola D, Rossi L, Schianca GPC, Maffioli P, et al.Sulfonylureas and their use in clinical practice.Arch Med Sci.2015;11(4):840-8. doi:10.5114/aoms.2015.53304Food and Drug Administration.Rezdiffra label.Grayson BE, Woods SC.Chapter 151: Insulin. In:Handbook of Biologically Active Peptides (Second Edition).New York NY: Elsevier; 2013.National Institute of Diabetes and Digestive and Kidney Diseases.Cirrhosis.Liu CY, Chen KF, Chen PJ.Treatment of liver cancer.Cold Spring Harb Perspect Med. 2015;5(9):a021535. doi:10.1101/cshperspect.a021535MedlinePlus.Type 1 diabetes.Gatselis NK, Zachou K, Koukoulis GK, Dalekos GN.Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics.World J Gastroenterol. 2015;21(1):60-83. doi:10.3748/wjg.v21.i1.60Centers for Disease Control and Prevention.Chronic liver disease and cirrhosis.Das BK, Gadad, DP.Impact of diabetes on the increased risk of hepatic cancer: an updated review of biological aspects.Diabetes Epidemiol Management.2021:4:100025.Additional ReadingCenters for Disease Control and Prevention.Diabetes risk factors.El-Serag HB, Kanwal F, Feng Z, Marrero JA, Khaderi S, Singal AG.Risk factors for cirrhosis in contemporary hepatology practices—findings from Texas Hepatocellular Carcinoma Consortium Cohort.Gastroenterology. 2020 Jul;159(1):376–7. doi:10.1053/j.gastro.2020.03.049MedlinePlus.How to prevent diabetes.Vento S, Cainelli F.Chronic liver diseases must be reduced worldwide: it is time to act.Lancet Glob Health.2022 Apr;10(4):e471-e472. doi:10.1016/S2214-109X(22)00047-X
28 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Chung W, Promrat K, Wands J.Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases.World J Hepatol.2020;12(9):533–557. doi:10.4254/wjh.v12.i9.533Loria P, Lonardo A, Anania F.Liver and diabetes. A vicious circle.Hepatol Res. 2013:43(1):51–64. doi:10.1111/j.1872-034X.2012.01031.xGarcia-Compean D, Orsi E, Kumar R, et al.Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.World J Gastroenterol.2022;28(8):775–793. doi:10.3748/wjg.v28.i8.775Banday MZ, Sameer AS, Nissar S.Pathophysiology of diabetes: An overview.Avicenna J Med.2020;10(4):174–188. doi:10.4103/ajm.ajm_53_20Mohamed J, Nazratun Nafizah AH, Zariyantey Ah, Budin SB.Mechanisms of diabetes-induced liver damage: the role of oxidative stress and inflammation.Sultan Qaboos Univ Med J.2016;16(2):e132–e141. doi:10.18295/squmj.2016.16.02.002Yang JD, Ahmed F, Mara KC, et al.Diabetes is associated with increased risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease.Hepatology. 2020;71(3):907–916. doi:10.1002/hep.30858Kumar R.Hepatogenous diabetes: An underestimated problem of liver cirrhosis.Indian J Endocrinol Metab.2018;22(4):552–559. doi:10.4103/ijem.IJEM_79_18National Institute of Diabetes and Digestive and Kidney Diseases.Insulin resistance and prediabetes.Orsi E, Grancini V, Menini S, Aghemo A, Puglieses G.Hepatogenous diabetes: Is it time to separate it from type 2 diabetes?Liver Int. 2017;37(7):950-962. doi:10.1111/liv.13337Lee YH, Cho Y, Lee BW, et al.Nonalcoholic fatty liver disease in diabetes. Part I: epidemiology and diagnosis.Diabetes Metab J.2019;43(1):31–45. doi:10.4093/dmj.2019.0011Akmal k, Hassabo H, Botrus G, et al.Impact of metformin on HCC prognosis.Cancer Res.2012;72 (8_Supplement):3594. doi:10.1158/1538-7445.AM2012-3594Ly Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne).2020;11:191. doi:10.3389/fendo.2020.00191Sumida Y, Yoneda M, Tokushige K, et al.Antidiabetic therapy in the treatment of nonalcoholic steatohepatitis.Int J Mol Sci.2020;21(6):1907. doi:10.3390/ijms21061907Cusi K, Orsak B, Bril F, et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: A randomized trial.Ann Intern Med. 2016;165(5):305-15. doi:10.7326/M15-1774National Institute of Diabetes and Digestive and Kidney Diseases.Alpha-glucosidase inhibitors.Seghieri M, Christensen AS, Andersen A, Solini A, Knop FK, Vilsboll T.Future perspectives on GLP-1 receptor agonists and GLP-1/glucagon receptor co-agonists in the treatment of NAFLD.Front Endocrinol (Lausanne).2018;9L649. doi:10.3389/fendo.2018.00649Hsu WH, Sue SP, Liang HL, et al.Dipeptidyl deptidase 4 inhibitors decrease the risk of hepatocellular carcinoma in patients with dhronic hepatitis C infection and type 2 diabetes mellitus: A nationwide study in Taiwan.Front Public Health. 2021;9:711723. doi:10.3389/fpubh.2021.711723Yen FS, Wei JCC, Yip HT, HWu CM, Hou MC, Hsu CC.Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: A nationwide population-based cohort study in Taiwan.Hepatol Int. 2021;15(1):179-90. doi:10.1007/s12072-020-10122-1Yang H, Choi E, Park E, et al.Risk of genital and urinary tract infections associated with SGLT‐2 inhibitors as an add‐on therapy to metformin in patients with type 2 diabetes mellitus: A retrospective cohort study in Korea.Pharmacol Res Perspect.2022;10(1):e00910. doi:10.1002/prp2.910Sola D, Rossi L, Schianca GPC, Maffioli P, et al.Sulfonylureas and their use in clinical practice.Arch Med Sci.2015;11(4):840-8. doi:10.5114/aoms.2015.53304Food and Drug Administration.Rezdiffra label.Grayson BE, Woods SC.Chapter 151: Insulin. In:Handbook of Biologically Active Peptides (Second Edition).New York NY: Elsevier; 2013.National Institute of Diabetes and Digestive and Kidney Diseases.Cirrhosis.Liu CY, Chen KF, Chen PJ.Treatment of liver cancer.Cold Spring Harb Perspect Med. 2015;5(9):a021535. doi:10.1101/cshperspect.a021535MedlinePlus.Type 1 diabetes.Gatselis NK, Zachou K, Koukoulis GK, Dalekos GN.Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics.World J Gastroenterol. 2015;21(1):60-83. doi:10.3748/wjg.v21.i1.60Centers for Disease Control and Prevention.Chronic liver disease and cirrhosis.Das BK, Gadad, DP.Impact of diabetes on the increased risk of hepatic cancer: an updated review of biological aspects.Diabetes Epidemiol Management.2021:4:100025.Additional ReadingCenters for Disease Control and Prevention.Diabetes risk factors.El-Serag HB, Kanwal F, Feng Z, Marrero JA, Khaderi S, Singal AG.Risk factors for cirrhosis in contemporary hepatology practices—findings from Texas Hepatocellular Carcinoma Consortium Cohort.Gastroenterology. 2020 Jul;159(1):376–7. doi:10.1053/j.gastro.2020.03.049MedlinePlus.How to prevent diabetes.Vento S, Cainelli F.Chronic liver diseases must be reduced worldwide: it is time to act.Lancet Glob Health.2022 Apr;10(4):e471-e472. doi:10.1016/S2214-109X(22)00047-X
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Chung W, Promrat K, Wands J.Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases.World J Hepatol.2020;12(9):533–557. doi:10.4254/wjh.v12.i9.533Loria P, Lonardo A, Anania F.Liver and diabetes. A vicious circle.Hepatol Res. 2013:43(1):51–64. doi:10.1111/j.1872-034X.2012.01031.xGarcia-Compean D, Orsi E, Kumar R, et al.Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.World J Gastroenterol.2022;28(8):775–793. doi:10.3748/wjg.v28.i8.775Banday MZ, Sameer AS, Nissar S.Pathophysiology of diabetes: An overview.Avicenna J Med.2020;10(4):174–188. doi:10.4103/ajm.ajm_53_20Mohamed J, Nazratun Nafizah AH, Zariyantey Ah, Budin SB.Mechanisms of diabetes-induced liver damage: the role of oxidative stress and inflammation.Sultan Qaboos Univ Med J.2016;16(2):e132–e141. doi:10.18295/squmj.2016.16.02.002Yang JD, Ahmed F, Mara KC, et al.Diabetes is associated with increased risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease.Hepatology. 2020;71(3):907–916. doi:10.1002/hep.30858Kumar R.Hepatogenous diabetes: An underestimated problem of liver cirrhosis.Indian J Endocrinol Metab.2018;22(4):552–559. doi:10.4103/ijem.IJEM_79_18National Institute of Diabetes and Digestive and Kidney Diseases.Insulin resistance and prediabetes.Orsi E, Grancini V, Menini S, Aghemo A, Puglieses G.Hepatogenous diabetes: Is it time to separate it from type 2 diabetes?Liver Int. 2017;37(7):950-962. doi:10.1111/liv.13337Lee YH, Cho Y, Lee BW, et al.Nonalcoholic fatty liver disease in diabetes. Part I: epidemiology and diagnosis.Diabetes Metab J.2019;43(1):31–45. doi:10.4093/dmj.2019.0011Akmal k, Hassabo H, Botrus G, et al.Impact of metformin on HCC prognosis.Cancer Res.2012;72 (8_Supplement):3594. doi:10.1158/1538-7445.AM2012-3594Ly Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne).2020;11:191. doi:10.3389/fendo.2020.00191Sumida Y, Yoneda M, Tokushige K, et al.Antidiabetic therapy in the treatment of nonalcoholic steatohepatitis.Int J Mol Sci.2020;21(6):1907. doi:10.3390/ijms21061907Cusi K, Orsak B, Bril F, et al.Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: A randomized trial.Ann Intern Med. 2016;165(5):305-15. doi:10.7326/M15-1774National Institute of Diabetes and Digestive and Kidney Diseases.Alpha-glucosidase inhibitors.Seghieri M, Christensen AS, Andersen A, Solini A, Knop FK, Vilsboll T.Future perspectives on GLP-1 receptor agonists and GLP-1/glucagon receptor co-agonists in the treatment of NAFLD.Front Endocrinol (Lausanne).2018;9L649. doi:10.3389/fendo.2018.00649Hsu WH, Sue SP, Liang HL, et al.Dipeptidyl deptidase 4 inhibitors decrease the risk of hepatocellular carcinoma in patients with dhronic hepatitis C infection and type 2 diabetes mellitus: A nationwide study in Taiwan.Front Public Health. 2021;9:711723. doi:10.3389/fpubh.2021.711723Yen FS, Wei JCC, Yip HT, HWu CM, Hou MC, Hsu CC.Dipeptidyl peptidase-4 inhibitors may accelerate cirrhosis decompensation in patients with diabetes and liver cirrhosis: A nationwide population-based cohort study in Taiwan.Hepatol Int. 2021;15(1):179-90. doi:10.1007/s12072-020-10122-1Yang H, Choi E, Park E, et al.Risk of genital and urinary tract infections associated with SGLT‐2 inhibitors as an add‐on therapy to metformin in patients with type 2 diabetes mellitus: A retrospective cohort study in Korea.Pharmacol Res Perspect.2022;10(1):e00910. doi:10.1002/prp2.910Sola D, Rossi L, Schianca GPC, Maffioli P, et al.Sulfonylureas and their use in clinical practice.Arch Med Sci.2015;11(4):840-8. doi:10.5114/aoms.2015.53304Food and Drug Administration.Rezdiffra label.Grayson BE, Woods SC.Chapter 151: Insulin. In:Handbook of Biologically Active Peptides (Second Edition).New York NY: Elsevier; 2013.National Institute of Diabetes and Digestive and Kidney Diseases.Cirrhosis.Liu CY, Chen KF, Chen PJ.Treatment of liver cancer.Cold Spring Harb Perspect Med. 2015;5(9):a021535. doi:10.1101/cshperspect.a021535MedlinePlus.Type 1 diabetes.Gatselis NK, Zachou K, Koukoulis GK, Dalekos GN.Autoimmune hepatitis, one disease with many faces: etiopathogenetic, clinico-laboratory and histological characteristics.World J Gastroenterol. 2015;21(1):60-83. doi:10.3748/wjg.v21.i1.60Centers for Disease Control and Prevention.Chronic liver disease and cirrhosis.Das BK, Gadad, DP.Impact of diabetes on the increased risk of hepatic cancer: an updated review of biological aspects.Diabetes Epidemiol Management.2021:4:100025.
Chung W, Promrat K, Wands J.Clinical implications, diagnosis, and management of diabetes in patients with chronic liver diseases.World J Hepatol.2020;12(9):533–557. doi:10.4254/wjh.v12.i9.533
Loria P, Lonardo A, Anania F.Liver and diabetes. A vicious circle.Hepatol Res. 2013:43(1):51–64. doi:10.1111/j.1872-034X.2012.01031.x
Garcia-Compean D, Orsi E, Kumar R, et al.Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives.World J Gastroenterol.2022;28(8):775–793. doi:10.3748/wjg.v28.i8.775
Banday MZ, Sameer AS, Nissar S.Pathophysiology of diabetes: An overview.Avicenna J Med.2020;10(4):174–188. doi:10.4103/ajm.ajm_53_20
Mohamed J, Nazratun Nafizah AH, Zariyantey Ah, Budin SB.Mechanisms of diabetes-induced liver damage: the role of oxidative stress and inflammation.Sultan Qaboos Univ Med J.2016;16(2):e132–e141. doi:10.18295/squmj.2016.16.02.002
Yang JD, Ahmed F, Mara KC, et al.Diabetes is associated with increased risk of hepatocellular carcinoma in cirrhosis patients with nonalcoholic fatty liver disease.Hepatology. 2020;71(3):907–916. doi:10.1002/hep.30858
Kumar R.Hepatogenous diabetes: An underestimated problem of liver cirrhosis.Indian J Endocrinol Metab.2018;22(4):552–559. doi:10.4103/ijem.IJEM_79_18
National Institute of Diabetes and Digestive and Kidney Diseases.Insulin resistance and prediabetes.
Orsi E, Grancini V, Menini S, Aghemo A, Puglieses G.Hepatogenous diabetes: Is it time to separate it from type 2 diabetes?Liver Int. 2017;37(7):950-962. doi:10.1111/liv.13337
Lee YH, Cho Y, Lee BW, et al.Nonalcoholic fatty liver disease in diabetes. Part I: epidemiology and diagnosis.Diabetes Metab J.2019;43(1):31–45. doi:10.4093/dmj.2019.0011
Akmal k, Hassabo H, Botrus G, et al.Impact of metformin on HCC prognosis.Cancer Res.2012;72 (8_Supplement):3594. doi:10.1158/1538-7445.AM2012-3594
Ly Z, Guo Y.Metformin and its benefits for various diseases.Front Endocrinol (Lausanne).2020;11:191. doi:10.3389/fendo.2020.00191
Sumida Y, Yoneda M, Tokushige K, et al.Antidiabetic therapy in the treatment of nonalcoholic steatohepatitis.Int J Mol Sci.2020;21(6):1907. doi:10.3390/ijms21061907
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