Insulin resistance in elderly patients with liver cirrhosis and diabetes mellitus

Objective To investigate the relationship between insulin resistance and hepatic function in elderly liver cirrhosis(LC)patients with diabetes(LC-DM)and to provide evidence for clinical treatment. Methods Thirty cases of elderly LC, 30 cases of elderly LC-DM, 30 younger patients(<60 years)with LC-DM and 30 healthy subjects were enrolled.Levels of fasting plasma glucose(FPG)and fasting plasma insulin(FINS)were examined to evaluate the homeostasis model for assessment of insulin resistance(HOMA-IR), which was used for comparison between the groups.Moreover, the relationship between HOMA-IR and the Child-Pugh classification was also analyzed. Results Patients in the elderly LC group were associated with significantly higher levels of FINS (9.58±3.62 vs.6.03±1.99 mU/L, P 0.05). In the elderly LC-DM group, more patients(66.7%)had Child-Pugh C liver function compared with the elderly LC group(36.7%)and the younger LC-DM group(40.0%)(both P<0.05). Of those in the LC and LC-DM groups, levels of HOMA-IR were 7.39±2.25 in patients with Child-Pugh C, which were significantly higher than those in patients with Child-Pugh B function(4.90±1.76)and with Child-Pugh A liver function(2.69±1.02)(both P<0.05). Conclusions Hyperinsulinemia and insulin resistance are more pronounced in elderly LC-DM than in elderly LC, with poor liver function and prognosis. Key words: Liver cirrhosis; Diabetes mellitus; Insulin resistance