A CLINICAL STUDY OF ORAL GLUCOSE TOLERANCE TEST IN CHRONIC LIVER DISEASE

  • Katuri Medical College
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Background: as liver is the principal organ for metabolism of the carbohydrates, chronic liver disease (CLD) may affect carbohydrate metabolism. Hence we can utilise oral glucose tolerance test (OGTT) to study the disturbances in carbohydrate metabolism in CLD. Objectives include: 1) To know clinical features and laboratory manifestations of chronic liver disease. 2) To know various results of OGTT in CLD. 3) To study various classes of cirrhosis (as in child-grading) Methods: Study was conducted over a period of 18 months in Katuri medical college where clinical, laboratory manifestations and OGTT results in 30 cases of CLD and 30 controls (age and sex matched) with cured respiratory tract infection. Age more than 65 years, pregnant women, patients with h/o diabetes, clinical features suggestive of chronic cholestatic diseases and h/o alcoholism in controls were excluded from the present study. Results: CLD was found to be more common in males (73.3%) than females. CLD was more common in lower socioeconomic status (63%). Male: female ratio is equal for chronic hepatitis C equals to one. Alcoholic cirrhosis, chronic alcohol hepatitis and primary hepatoma with cirrhosis were seen only in male and cryptogenic cirrhosis was seen in only female. Most of the cases had anemia. Cirrhosis is the most common cause for CLD (66.6%/20 cases). OGTT showed rise in blood sugar levels in cases which was significant when compared with control group (p<0.05). OGTT showed impaired response in 46.6% cases, impaired glucose tolerance (IGT) in 23.3%, diabetic response in 23.3% and normal response in 53.3% cases. Cirrhosis is the most common (78.5%) cause for impaired glucose response. Conclusions: It can be concluded that CLD is more common in male and lower socioeconomic status. There is significant impaired response to glucose load in CLD. Cirrhosis, among CLD?s is the most common etiology for impaired response.

  1. Chronic liver disease is??????????????????? common????????????????? in???? males??????? and?????? in????? low socioeconomic Male are more malnourished than females.
  2. Cirrhosis is the most common and typical cause of chronic liver Child- Pugh?s grading is useful to know the severity of cirrhosis. Hepatitis C infection is the most typical cause of chronic hepatitis.
  3. Among Liver function tests, synthetic functions like serum bilirubin, serum albumin, serum globulin, and prothrombin time are useful in assessing the functional reserve in chronic liver Enzyme estimations like AST, ALT, AP, etc., are helpful in the probable etiology of chronic liver disease. Liver biopsy is useful in confirming the condition and severity.
  4. Impaired glucose response is most common in cirrhosis, more common in class B Child-Pugh?s In hepatitis, an impaired response is common in Hepatitis C. Impaired response is more common in females than males. Fasting hypoglycemia can be seen in hepatoma with cirrhosis.
  5. 94Thirty cases of chronic liver disease were studied in detail. Data regarding the clinical features and investigations done are present in the master
  6. Chronic liver disease is more common in males (73.3%) than
  7. Chronic liver disease is more common in lower socioeconomic status (63%). Male: female ratio is equal for chronic hepatitis C; it is 25 for post necrotic cirrhosis; it is 3 for chronic hepatitis B. Alcoholic cirrhosis, chronic alcohol hepatitis, and primary hepatoma with cirrhosis is seen only in males, and cryptogenic cirrhosis is seen only in female. Among cases males have lower BMI (50.09%), compared to females (35.7%) are malnourished.
  8. Anorexia, fatigue, and distention of abdomen are common symptoms, seen in 80%, 70%, and 50%, History of alcoholism is most common (40%). Others like blood transfusion, extramarital sex, childhood history, etc also contribute significantly to development of chronic liver disease. Ascites is the most common (53.3%) sign; hepatomegaly, icterus, and clubbing are also common
  9. Most of the cases are anemic (mean-9.97mg%), 63% of males are anemic, and 50% of females are
  10. In peripheral smear, most of them show anemia of chronic disease (normocytic normochromic anemia).
  11. 6 % (20 cases) showed normocytic normochromic response rest showed microcytic hypochromic response, because of inadequate intake or chronic blood loss through varices.
  12. Cirrhosis is the most common cause (66.6%/20 cases) for chronic liver disease, with post necrotic cirrhosis and alcoholic cirrhosis causing 50% Child-Pugh?s grading is very useful to know the severity of cirrhosis. Among cirrhosis, 70% were in class-A, and 30% were in class-B. Class-B cirrhotics are associated with hepatic encephalopathy in 20% and esophageal varices in 16.6%. Among hepatitis virus infection, Hepatitis C cause majority (36.6%) of chronic liver disease
  13. Thirty patients of cured respiratory tract infection (I.P/O.P) were studied in detail and investigated; age and sex-matched were taken as control
  14. Those who have given volunteered and gave written consent for OGTT were subjected to OGTT, venous blood, and urine was serially analyzed for sugar at fasting, 1/2hr, 1hr, 1 1/2hr, and 2hr. Data according to WHO criteria (Table 3 & 4) is collected and compare between case and control groups using ?paired T? test to know the
  15. There is a significant (p-0.00001) rise in blood sugar levels in cases compared to control group. After glucose load and there was diabetic response in 3% cases and IGT in 23.3% cases.
  16. Cirrhosis is the most common (78.57%) cause for impaired glucose response. There is a correlation between impaired glucose response and Child-Pugh?s classification (83.3% in class-B and 50% in class-B). Chronic hepatitis cause impaired response in 4%. Impaired glucose response is typical in females (50%) than males (45.4%). Fasting hypoglycemia is seen in the case of cirrhosis with hepatoma.
   

Abhilash Tadiboina and Kandula Venkateswara Reddy (2019); A CLINICAL STUDY OF ORAL GLUCOSE TOLERANCE TEST IN CHRONIC LIVER DISEASE, Int. J. of Adv. Res., 7 (11), 590-603, ISSN 2320-5407. DOI URL: https://dx.doi.org/10.21474/IJAR01/10048

Abhilash tadiboina
3rd year postgraduate

DOI:

Article DOI: 10.21474/IJAR01/10048      
DOI URL: https://dx.doi.org/10.21474/IJAR01/10048

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