Prevalence of insulin resistance among patients with cirrhosis of liver in Government Royapettah Hospital, Chennai

Background: Liver is the major site for carbohydrate, protein and lipid metabolism. In liver cirrhosis, derangements in metabolic functions can happen. Liver cirrhosis can lead to insulin resistance then impaired glucose tolerance and finally diabetes. The occurrence of insulin resistance in cirrhosis has definite clinical implications like rapid progression to fibrosis and increased risk of gastrointestinal haemorrhage and hepatocellular carcinoma. Objectives: This study was done to find the prevalence of insulin resistance in patients with cirrhosis in Government Royapettah Hospital due to varied etiology. Materials and methods: It was a cross sectional study done on 50 subjects in Government Royapettah Hospital. Patients were selected according to the inclusion criteria. A detailed history was taken, and a thorough clinical examination was done followed by further investigations, all of which were recorded in a pre-designed, structured proforma. Insulin resistance was assessed using three indices: HOMA1 IR, HOMA2 IR calculator and TyG index. Results: The mean age of the population was 46.18± 9.78 years. 94% of patients were males and 6% were females. Among the fifty subjects included, 34% had insulin resistance according to HOMA 1 IR (p 0.024) and 28% with HOMA2 IR (p 0.002). Insulin resistance using both HOMA 1 and 2 was significantly increased in Child Turcott Pugh C (p <0.001 for both). Insulin resistance was not demonstrated in any of subjects using TyG index. There was positive correlation between insulin resistance and fasting glucose and insulin. Conclusion: Insulin resistance is demonstrated in liver cirrhosis which is increased with advancing disease. It can be concluded that regular monitoring of glycemic status is mandatory in these patients who would have definite bearing upon treatment strategy.