An audit of pharmacological management of blood sugar in patients with co-existent cirrhosis and diabetes mellitus of a Sri Lankan liver-unit

Abstract

INTRODUCTION AND OBJECTIVES: Diabetes mellitus (DM) and cirrhosis often coexist. Pharmacological management of DM in them is challenging as most oral hypoglycaemic drugs (OHG) are either metabolised by the liver or cause side effects. However, there are no guidelines on blood sugar control in cirrhotic patients with DM. METHODS: Therefore, we did a descriptive study on pharmacological management of blood sugar in all consenting, consecutive cirrhosis patients with DM attending the Liver-Unit of a Teaching-Hospital, Sri Lanka during September-2017 using an interviewer administered questionnaire.RESULTS: A total of 80 patients (male - 52 (65%), mean age 61±9.1 years) were studied. 59(73.8%) of them have developed cirrhosis after diagnosis of DM. Aetiology of cirrhosis were; cryptogenic - 38(47.5%), alcohol- 21(28.3%), Non-alcoholic fatty liver disease - 18(22.5%). 53 (66.3%) had decompensated-cirrhosis, of all cirrhotic patients 71(88.8%) were on OHG,17(21.3%) on insulin and 10 (12.5%) on both. Main side effects of anti-diabetic medications were, hypoglycaemia -19 (23.8%), poor appetite -10 (12.5%) and upper gastro-intestinal symptoms -3(3.8%).64 (80.0%) of patient's anti-diabetic medications were changed after diagnosis of cirrhosis,and the main changes were; metformin stopped - 25(31.3%), insulin started - 14(17.5%), metformin was changed to sulphonylurea -13(16.3%), sitagliptan added - 8(10%), conversion of long-acting drugs to short-acting ones -3 (3.8%), Compensated- cirrhotic patients 21 (77.8%) were on metformin while 16 (59.3%) were on short-acting• sulphonylureas. Decompensated- cirrhotic patients; 29 (54.7%) were on metformin and 36(67.9%) were on short• acting-sulphonylureas. CONCLUSION: Majority of compensated-cirrhotic patients were on metformin while a significant proportion of decompensated cirrhotic patients were on short-acting-sulphonylureas without major complications.