Title: Clinico-pathological profile of hepatic involvement in type 2 diabetes mellitus patients attending tertiary care hospital in Maharashtra
Authors: Dr Harshal Bhitkar, Dr Santosh Thorat
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.167
Abstract
Introduction
Liver is the principle organ for degradation of insulin. In type 2 diabetes mellitus spectrum of liver changes occurs from simple steatosis (NAFL), non-alcoholic steatohepatitis (NASH) ,cirrhosis to hepatocellular carcinoma . These all diseases are included in common entity as non-alcoholic fatty liver disease (NAFLD)1.
Most of the patients with type 2 diabetes mellitus have clinical characteristics of insulin resistance syndrome including obesity (visceral fat), hypertension, glucose intolerance and typically dyslipidemia2. This obesity and insulin resistance have been strongly associated with NAFLD.
In most of instances NAFLD is silent disease so it is very much difficult to diagnose in early stages. NAFLD progresses very slowly however in 20% it progresses rapidly. Progression in NAFL to fibrosis stage 1 is every 14 years and every 7 years in NASH which is further increases in the presence of arterial hypertension. Cirrhosis and liver failure occurs in 11% to 20% NASH patients over 10 to 15 years3.
There is 2.2 fold increases in overall mortality in NAFLD with the most common cause of death being cardiovascular diseases. Patient with NASH have an increased liver related mortality rate with decompensated liver failure and HCC corresponding to 2%. The mortality rate of type 2 diabetes mellitus patients due to cirrhosis is more than twice the general population, further more they tend to have poor prognosis with high rate of cirrhosis and mortality3.
In the modern era of metabolic syndrome as obesity and type 2 diabetes mellitus epidemic is growing NASH prevalence is also increasing from 30% to 60% in western population. It is expected to become leading cause of liver transplant by 20204. In India also prevalence is also found to be around 60% in many studies.
Thus for the diagnosis of NAFLD requires high index of suspicion particularly in obese patient over age of 45 years with history of type 2 diabetes mellitus.
Present study was conducted to determine the Clinico-pathological profile of hepatic involvement in type 2 diabetes mellitus patients attending medicine opd at tertiary care hospital in Maharashtra.
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