Diabetic patients with liver fibrosis are at an increased risk of severe hypoglycemia, a study has found. Liver fibrosis is a disease in which the liver tissue becomes hard, and it interferes with the contact between hepatocytes and blood, leading to deterioration of liver function. Liver fibrosis can be exacerbated by cirrhosis and liver cancer. The most common cause is non-alcoholic fatty liver, which is caused by the accumulation of excess fat in the liver.
A research team led by Professor Lee Yong-ho of the Department of Endocrinology at Yonsei University Severance Hospital and Professor Kyung-do Han of the Department of Information, Statistics and Actuarial Sciences at Soongsil University revealed on the 3rd that the risk of severe hypoglycemia in diabetic patients with liver fibrosis was 38% higher than in patients without liver fibrosis. The results of this study were published in the latest issue of JAMA Network Open, a journal published by the American Medical Association. Hypoglycemia due to low blood glucose levels is a common complication in diabetes mellitus. The Korean Diabetes Association defines severe hypoglycemia, the most dangerous stage of hypoglycemia, as a condition that requires external help, such as a visit to the emergency room. Severe hypoglycemia increases the risk of dementia and cardiovascular disease, and can lead to loss of consciousness and even death. Patients need frequent blood sugar control in their daily life, and their quality of life deteriorates.
There have been many studies on risk factors that cause severe hypoglycemia, but no studies have identified nonalcoholic fatty liver as a risk factor.
To investigate the effect of nonalcoholic fatty liver on severe hypoglycemia, the research team investigated the Fatty Liver Index in patients treated for severe hypoglycemia and revealed the risk of severe hypoglycemia according to the fatty liver index. First, by using big data from the National Health Insurance Corporation, it was confirmed whether or not severe hypoglycemia was treated for regarding 2 million adults with type 2 diabetes between 2009 and 2012. During the follow-up period of 5.2 years, 45,135 patients were treated for severe hypoglycemia. The average age of patients with severe hypoglycemia was 67.9 years, which was 10.7 years higher than the average age of patients without severe hypoglycemia of 57.2 years. The average body mass index (BMI) was 24.3, 0.8 lower than that of the control group. The fatty liver index was then used to determine the effect of nonalcoholic fatty liver on the occurrence of severe hypoglycemia. The fatty liver index is a number that measures the severity of fatty liver using liver enzymes. According to this index, all diabetic patients were divided into a low index group (FLI60).
The number of patients with severe hypoglycemia in each group was 3.6, 3.4, and 4.4 out of 100, respectively, which increased by 26% in the group with high fatty liver index compared to the group with low fatty liver index. Fatty liver patients with hepatic fibrosis had a 38% increased risk of severe hypoglycemia compared to diabetic patients without liver abnormalities. In addition, in analyzing the fatty liver index by dividing it into 10 deciles, it was confirmed that the risk of severe hypoglycemia according to the fatty liver index draws a J-shaped curve. The fatty liver index with the lowest probability of developing severe hypoglycemia was 12-54 in men and 7-37 in women.
Professor Lee Yong-ho said, “The significance of this study is that it revealed that patients with type 2 diabetes mellitus with fatty liver have a high risk of developing severe hypoglycemia. Considering the risk of hypoglycemia, drug treatment tailored to the patient’s characteristics will increase patient safety.” .
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