DOI: http://dx.doi.org/10.18203/2349-3933.ijam20190116

Evaluation of liver function in acute complications of type 2 diabetes mellitus

Periyasamy Sivakumar, Thiyagarajan Manjuladevi Moonishaa, Neethu George, Reena Savariraj

Abstract


Background: Diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic state (HHS) are the acute complications of Type 2 Diabetes Mellitus (T2DM). The aim was to evaluate the role of liver function parameters in T2DM patients with DKA and HHS.

Methods: This descriptive study included 50 subjects in each of the following four groups: non-T2DM, T2DM without acute complications, T2DM with DKA, T2DM with HHS. Data on demography, clinical and lab diagnosis, as well as liver function parameters were collected from May 2017 to October 2017. The baseline data and liver function parameters were compared across the study groups.

Results: There was significant hyperglycemia and associated baseline electrolyte, Arterial Blood Gas (ABG) analysis changes in acute complications of T2DM. Besides GGT, the serum total and direct bilirubin levels were also higher in T2DM cases with DKA. Significant levels of hypoalbuminemia and hyperglobulinemia along with raised SGPT and ALP levels were seen in acute complications of T2DM, especially in HHS complicating T2DM.

Conclusions: Decreased serum albumin levels, along with elevated liver enzymes-SGPT, ALP, and GGT characterized the acute complications of T2DM, with specific alterations of liver function parameters seen in DKA and HHS cases.


Keywords


Acute complications of type 2 diabetes mellitus, Diabetic ketoacidosis, Hyperosmolar hyperglycaemic state, Liver function

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References


International Diabetes Federation. IDF Diabetes Atlas. 7th ed. Brussels, Belgium: International Diabetes Federation; 2015.

WHO. Diabetes; 2017. Available at: http://www.who.int/mediacentre/factsheets/fs312/en/. Accessed 28 October 2017).

Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diab Care. 2009;32(7):1335-43.

Joint British Diabetes Societies Inpatient Care Group. The Management of Diabetic Ketoacidosis in Adults, 2nd ed. UK: Joint British Diabetes Societies Inpatient Care Group; 2013.

Tohidi M, Harati H, Hadaegh F, Mehrabi Y, Azizi F. Association of liver enzymes with incident type 2 diabetes: a nested case control study in an Iranian population. BMC Endocrine Dis. 2008;8(1):5.

Takaike H, Uchigata Y, Iwasaki N, Iwamoto Y. Transient elevation of liver transaminase after starting insulin therapy for diabetic ketosis or ketoacidosis in newly diagnosed type 1 diabetes mellitus. Diab Res Clin Prac. 2004;64(1):27-32.

Bai F, Jiang FF, Lu JJ, Ma SG, Peng YG, Jin Y, et al. The impact of hyperglycaemic emergencies on the kidney and liver. J Diab Res. 2013:1-8.

Rodríguez-Segade S, Rodríguez J, Mayan D, Camiña F. Plasma albumin concentration is a predictor of HbA1c among type 2 diabetic patients, independently of fasting plasma glucose and fructosamine. Diab Care. 2005;28(2):437-9.

Cheng PC, Hsu SR, Cheng YC. Association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus. J Diab Res. 2016:1-5.

American Diabetes Association. Classification and diagnosis of diabetes. Diab Care. 2015;38(1):S8-16.

Hood JL, Scott MG. Physiology and disorders of water, electrolyte, and acid-base metabolism. In: Carl A. Burtis, Edward R. Ashwood, David E Bruns, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. New Delhi: Elsevier. 2012;1628.

Scott MG, Legrys VA, Hood JL. Electrolytes and blood gases. In: Burtis CA, Ashwood ER, Bruns DE, eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th ed. New Delhi: Elsevier; 2012:815.

Barrett EJ, Sherwin RS. Gastrointestinal manifestations of diabetic ketoacidosis. Yale J Biol Med. 1983;56(3):175.

Jain SK, McVie R. Hyperketonaemia can increase lipid peroxidation and lower glutathione levels in human erythrocytes in vitro and in type 1 diabetic patients. Diabetes. 1999;48(9):1850-5.

Farasat T, Sharif S, Manzoor F, Naz S. Serum bilirubin is significantly associated with HbA1C in type 2 diabetic subjects. Endocrinol Metab Inter J. 2017;5(6):3.

Venkataramana G, Indira P, Rao D. Changes of plasma total proteins, albumin and fibrinogen in type 2 diabetes mellitus: a pilot study. Ind J Basic Applied Med Res. 2013;7(2):679-85.

Malawadi BN, Adiga U. Plasma Proteins in Type 2 Diabetes Mellitus. IOSR. J Biotechnol Biochem. 2016;2(5):1-3.

Folsom AR, Ma J, Eckfeldt JH, Nieto FJ, Metcalf PA, Barnes RW. Atherosclerosis risk in communities (aric) study investigators: low serum albumin: association with diabetes mellitus and other cardiovascular risk factors but not with prevalent cardiovascular disease or carotid artery intima-media thickness. Ann Epidemiol. 1995;5(3):186-91.

Herrmann FR, Safran C, Levkoff SE, Minaker KL. Serum albumin level on admission as a predictor of death, length of stay, and readmission. Arch Inter Med. 1992;152(1):125-30.

Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, et al. The APACHE III prognostic system: risk prediction of hospital mortality for critically III hospitalized adults. Chest. 1991;100(6):1619-36.

Hisalkar PJ, Patne AB, Fawade MM. Inter J Biol Med Res. Int J Biol Med Res. 2012;3(2):1796-800.