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Diabetes mellitus as a risk factor for serious liver disease

It seems that every time you turn around, you find another argument against obesity – as if we needed any, but the research data continues to build.

The latest report, published in today’s edition of the Canadian Medical Association Journal is by a group of researchers led by Dr. Joel Ray, associate professor of medicine at the University of Toronto and a physician at St. Michael’s Hospital in Toronto.

The study reports that adults who are newly diagnosed with Type 2 diabetes are much more likely to subsequently develop liver cirrhosis, failure or require a transplant than the rest of the population. What they’re saying in effect is that people newly diagnosed with Type 2 diabetes may slowly undergo liver damage from excess accumulation of liver fat over many years before and after the onset of diabetes.

In a story published in today’s Globe & Mail, “It is damage to your body,” said Dr. Ray. “The idea is there’s a wear and tear effect on a lot of systems.”

Dr. Ray said the research stems from a growing understanding of the relationship between insulin resistance and fat metabolism. In recent years, scientists have determined that the liver can be a major storehouse of fat. The accumulation of fat in the liver among those who don’t drink excessive amounts of alcohol is known as non-alcoholic fatty liver disease.

Dr. Ray and his colleagues believe it may be an indicator that a person is resistant to their body’s insulin, which is needed to regulate blood sugar. Over time, this resistance can cause the pancreas to “burn out,” he said, and contribute to the development of diabetes and liver injury.

The results of the study show the incidence rate of serious liver disease was 8.19 per 10 000 person-years among those with newly diagnosed diabetes and 4.17 per 10 000 person-years among those without diabetes. The unadjusted hazard ratio was 1.92 (95% confidence interval [CI] 1.83–2.01). After adjustment for age, income, urban residence, health care utilization and pre-existing hypertension, dyslipidemia, obesity and cardiovascular disease, the hazard ratio was 1.77 (95% CI 1.68–1.86).

Interpretation: Adults with newly diagnosed diabetes appeared to be at higher risk of advanced liver disease, also known as diabetic hepatopathy. Whether this reflects non-alcoholic fatty liver disease or direct glycemic injury of the liver remains to be determined.

The study examined data from nearly 440,000 Ontario residents recently diagnosed with diabetes and more than two million people without diabetes from 1994 to 2006. At the end of the study period about eight in every 10,000 people with diabetes had developed serious liver disease, compared to approximately four in every 10,000 people without diabetes.

Although the risk of developing kidney damage is higher than the risk of liver disease for those with Type 2 diabetes, researchers highlight the fact that there are few viable and readily available therapies for patients with serious liver damage.

Dr. Ray and his colleagues suggest that it may be time to consider screening people with Type 2 diabetes for liver disease.

On a personal note, it’s pure coincidence but my family doctor ordered some liver function tests on me a couple of weeks ago because he was thinking about prescribing Lamisil for what appears to be some bilateral toe fungus issues. The podiatrist I’m seeing on the other hand thinks it’s not fungus but simply poor circulation in my toes. The podiatrist said he would prefer to treat it that way rather than ingesting a medication that has potential negative effects on the liver.

Sources include:

http://www.theglobeandmail.com/life/health/liver-disease-may-be-associated-with-type-2-diabetes-a-new-study-finds/article1612414/ http://www.cmaj.ca/cgi/content/abstract/cmaj.092144v1?ijkey=e27f8e8526203db0bc73036fe6a7cf987ff040d7&keytype2=tf_ipsecsha
http://www.medscape.com/viewarticle/434079_4
http://www.stmichaelshospital.com/research/profile.php?id=ray&
http://bodyandhealth.canada.com/drug_info_details.asp?brand_name_id=610
http://www.drugs.com/sfx/lamisil-side-effects.html
http://www.rush.edu/Rush_Document/Glycogen%20Hepatopathy,0.pdf

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