Skip to main content
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care
  • Subscribe
  • Log in
  • My Cart
  • Follow ada on Twitter
  • RSS
  • Visit ada on Facebook
Diabetes Care

Advanced Search

Main menu

  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
  • More from ADA
    • Diabetes
    • Clinical Diabetes
    • Diabetes Spectrum
    • ADA Standards of Medical Care
    • ADA Scientific Sessions Abstracts
    • BMJ Open Diabetes Research & Care

User menu

  • Subscribe
  • Log in
  • My Cart

Search

  • Advanced search
Diabetes Care
  • Home
  • Current
    • Current Issue
    • Online Ahead of Print
    • Special Article Collections
    • ADA Standards of Medical Care
  • Browse
    • By Topic
    • Issue Archive
    • Saved Searches
    • Special Article Collections
    • ADA Standards of Medical Care
  • Info
    • About the Journal
    • About the Editors
    • ADA Journal Policies
    • Instructions for Authors
    • Guidance for Reviewers
  • Reprints/Reuse
  • Advertising
  • Subscriptions
    • Individual Subscriptions
    • Institutional Subscriptions and Site Licenses
    • Access Institutional Usage Reports
    • Purchase Single Issues
  • Alerts
    • E­mail Alerts
    • RSS Feeds
  • Podcasts
    • Diabetes Core Update
    • Special Podcast Series: Therapeutic Inertia
    • Special Podcast Series: Influenza Podcasts
    • Special Podcast Series: SGLT2 Inhibitors
    • Special Podcast Series: COVID-19
  • Submit
    • Submit a Manuscript
    • Journal Policies
    • Instructions for Authors
    • ADA Peer Review
Online Letters: Observations

Liver Transplantation: A Potential Cure for Hepatogenous Diabetes?

  1. Maria Pallayova, MD, PHD1,
  2. Violet Wilson, RN2,
  3. Reggie John, MBBS2 and
  4. Shahrad Taheri, MBBS, PHD, FRCP1,2
  1. 1Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country/National Institute for Health Research, University of Birmingham, Birmingham, United Kingdom
  2. 2Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, United Kingdom
  1. Corresponding author: Shahrad Taheri, staheri{at}me.com.
Diabetes Care 2013 Jul; 36(7): e97-e97. https://doi.org/10.2337/dc13-0400
  • Article
  • Info & Metrics
  • PDF
Loading

This article has a correction. Please see:

  • Liver Transplantation: A Potential Cure for Hepatogenous Diabetes? Diabetes Care 2013;36:e97 - January 01, 2015

Hepatogenous diabetes is a common complication of liver cirrhosis (1). It develops gradually as a result of profound insulin resistance and increased endogenous glucose production that unmask or lead to pancreatic β-cell dysfunction. Since the liver plays a major role in maintaining glucose homeostasis, it is important to investigate whether liver transplantation (LT) could prevent or cure hepatogenous diabetes in patients with liver cirrhosis. We report a case of 2-year diabetes remission in a 49-year-old Chinese female LT recipient treated with tacrolimus who had previously been on intensive insulin therapy for 5 years.

The patient was diagnosed with diabetes in July 2006 at the age of 43 years, when she presented to the clinic because of severe ascites and peripheral edema. Subsequent investigations revealed the presence of hepatitis B with secondary liver cirrhosis, complicated by portal hypertension and esophageal varices. Her initial HbA1c was 12.8% (116 mmol/mol), and the patient already had bilateral nonproliferative diabetic retinopathy. Intensive insulin therapy was initiated (36 IU/day).

At the 3-month follow-up, the patient’s overall glycemic control improved, as reflected by an HbA1c of 6.6% (49 mmol/mol) that further decreased and remained stable at >6% (42 mmol/mol) while on a basal-bolus regimen. Since January 2009, the diabetes control had deteriorated, with an HbA1c of 7.6 (60 mmol/mol) to 8.4% (68 mmol/mol), along with a progression of diabetic retinopathy with proliferative changes. Concurrently, the patient was under regular review by hepatologists. Additional medications included propranolol, spironolactone, and tenofovir.

In March 2011, the patient successfully underwent LT and was subsequently treated with steroids, tacrolimus, and mycophenolate mofetil. Her glycemic control improved after prednisolone was discontinued. In July 2011, the HbA1c was 5.0% (31 mmol/mol). Because of recurring nighttime hypoglycemia, the doses of basal insulin were gradually decreased, and the overall insulin therapy was further adjusted.

Since January 2012, the patient has been completely off insulin/any antidiabetic medication while continuing her antiviral (tenofovir) and combined immunosuppressive therapy (tacrolimus plus mycophenolate). The HbA1c level continued to remain good at 5.2 (33 mmol/mol) to 6.3% (45 mmol/mol). Since LT, the patient's kidney function has been stable, and her BMI had decreased from 27 to 24 kg/m2 after regression of ascites and peripheral edema.

The cause of diabetes resolution in this case remains less well-understood. Although current evidence suggests that immunosuppressive agents generally increase risk of diabetes after organ transplantations (2), our observations strengthen previous findings (3,4) of hepatogenous diabetes resolution after LT in some of the cyclosporine-treated patients with post–hepatitis B or C cirrhosis. It is important to point out that tacrolimus rather than cyclosporine is associated with hyperglycemia, one of the main side effects ascribed to reduced insulin secretion (5). Surprisingly, and as shown in our case, successful LT with subsequent tacrolimus therapy led to a complete diabetes remission in an insulin-treated cirrhotic patient. The findings suggest that normalized glucose production and insulin sensitivity after LT may reverse β-cell dysfunction and thus cure hepatogenous diabetes in patients with preserved β-cell function. Further prospective studies should be conducted to test this hypothesis.

Acknowledgments

M.P. is supported by the National Institute for Health Research through the Collaborations for Leadership in Applied Health Research and Care for Birmingham and Black Country (CLAHRC-BBC) programme and by the Slovakian Diabetes Association/Lilly Diabetes Clinical Research Initiative Postgraduate Academic Fellowship Programme for Young Researchers in Diabetes. S.T. is funded through the CLAHRC-BBC. The views expressed in this publication are not necessarily those of the National Institute for Health Research, the Department of Health, NHS Partner Trusts, University of Birmingham, or the CLAHRC-BBC Theme 8 Steering Group.

No potential conflicts of interest relevant to this article were reported.

M.P. drafted the initial letter. V.W., R.J., and S.T. provided care for the patient. All authors contributed to discussions that resulted in the final letter. S.T. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

  • © 2013 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

References

  1. ↵
    1. García-Compean D,
    2. Jaquez-Quintana JO,
    3. Maldonado-Garza H
    . Hepatogenous diabetes. Current views of an ancient problem. Ann Hepatol 2009;8:13–20
    OpenUrlPubMed
  2. ↵
    1. Gomes MB,
    2. Cobas RA
    . Post-transplant diabetes mellitus. Diabetol Metab Syndr 2009;1:14
    OpenUrlCrossRefPubMed
  3. ↵
    1. Perseghin G,
    2. Mazzaferro V,
    3. Sereni LP,
    4. et al
    . Contribution of reduced insulin sensitivity and secretion to the pathogenesis of hepatogenous diabetes: effect of liver transplantation. Hepatology 2000;31:694–703
    OpenUrlCrossRefPubMedWeb of Science
  4. ↵
    1. Vlaeminck-Guillem V,
    2. Guillem P,
    3. Dequiedt P,
    4. Pruvot FR,
    5. Fontaine P
    . Liver transplantation eliminates insulin needs of a diabetic patient. Diabetes Metab 2000;26:493–496
    OpenUrlPubMed
  5. ↵
    1. Radu RG,
    2. Fujimoto S,
    3. Mukai E,
    4. et al
    . Tacrolimus suppresses glucose-induced insulin release from pancreatic islets by reducing glucokinase activity. Am J Physiol Endocrinol Metab 2005;288:E365–E371
    OpenUrlAbstract/FREE Full Text
Back to top
Diabetes Care: 44 (3)

Current Issue

March 2021
Volume 44, Issue 3

  • Current Issue
  • Index by Author
  • Issue Archive
  • Podcasts
Sign up to receive current issue alerts
View Selected Citations (0)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Diabetes Care.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Liver Transplantation: A Potential Cure for Hepatogenous Diabetes?
(Your Name) has forwarded a page to you from Diabetes Care
(Your Name) thought you would like to see this page from the Diabetes Care web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Liver Transplantation: A Potential Cure for Hepatogenous Diabetes?
Maria Pallayova, Violet Wilson, Reggie John, Shahrad Taheri
Diabetes Care Jul 2013, 36 (7) e97; DOI: 10.2337/dc13-0400

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Add to Selected Citations
Share

Liver Transplantation: A Potential Cure for Hepatogenous Diabetes?
Maria Pallayova, Violet Wilson, Reggie John, Shahrad Taheri
Diabetes Care Jul 2013, 36 (7) e97; DOI: 10.2337/dc13-0400
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Acknowledgments
    • References
  • Info & Metrics
  • PDF

Related Articles

Cited By...

More in this TOC Section

  • Artifactual Hypoglycemia: An Old Term for a New Classification
  • Tyrosine Kinase Inhibitor Sunitinib Allows Insulin Independence in Long-standing Type 1 Diabetes
  • FGF23 in Type 2 Diabetic Patients: Relationship With Bone Metabolism and Vascular Disease
Show more Online Letters: Observations

Similar Articles

Navigate

  • Current Issue
  • Standards of Care Guidelines
  • Online Ahead of Print
  • Archives
  • Submit
  • Subscribe
  • Email Alerts
  • RSS Feeds

More Information

  • About the Journal
  • Instructions for Authors
  • Journal Policies
  • Reprints and Permissions
  • Advertising
  • Privacy Policy: ADA Journals
  • Copyright Notice/Public Access Policy
  • Contact Us

Other ADA Resources

  • Diabetes
  • Clinical Diabetes
  • Diabetes Spectrum
  • Scientific Sessions Abstracts
  • Standards of Medical Care in Diabetes
  • BMJ Open - Diabetes Research & Care
  • Professional Books
  • Diabetes Forecast

 

  • DiabetesJournals.org
  • Diabetes Core Update
  • ADA's DiabetesPro
  • ADA Member Directory
  • Diabetes.org

© 2021 by the American Diabetes Association. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548.