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Diabetes mellitus bei Patient:innen mit Leberzirrhose – eine besondere therapeutische Herausforderung

Diabetes Mellitus in Patients with Liver Cirrhosis—A Special Therapeutic Challenge

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Journal für Gastroenterologische und Hepatologische Erkrankungen Aims and scope

Zusammenfassung

Die Therapie des Diabetes mellitus bei Patient:innen mit gleichzeitig bestehender Leberzirrhose stellt eine besondere therapeutische Herausforderung dar. Die Leber ist ein zentrales Organ der Glukosehomöostase und daher sind Erkrankungen, welche mit einer Einschränkung der Leberfunktion einhergehen auch häufig mit Störungen im Glukosemetabolismus vergesellschaftet. Eine Leberzirrhose kann hierbei, je nach aktuellem Krankheitsstadium mit einer ausgeprägten Insulinresistenz oder einem stark erhöhten Hypoglykämierisiko einhergehen. Die Ursachen für diese stark wechselnden Effekte auf den Glukosestoffwechsel sind multifaktoriell und werden durch hepatische und systemische Faktoren verursacht. Die stark eingeschränkten therapeutischen Möglichkeiten zur Behandlung des Diabetes mellitus bei fortgeschrittener Leberzirrhose und die dadurch häufige Notwendigkeit der Insulintherapie spielen hier ebenfalls eine Rolle. Andererseits kann sich eine schlechte glykämische Kontrolle negativ auf den Verlauf von hepatischen Erkrankungen auswirken, sodass eine gute glykämische Kontrolle insbesondere in diesem Kollektiv von großer Bedeutung ist.

Abstract

Therapy of diabetes mellitus in patients with concomitant liver cirrhosis is a special challenge. The liver is a key player in glucose homeostasis. Therefore, disturbances of hepatic metabolism are often accompanied by disorders in glucose metabolism. Depending on the stage of the disease, either pronounced insulin resistance or severe risk of hypoglycemia might accompany liver cirrhosis. The causes are multifactorial and comprise hepatic as well as systemic changes. Limited usability of antidiabetic medication and frequent necessity of insulin usage play an important role, also. Additionally, glycemic control has major impact on development and progression of many hepatic disorders including liver cirrhosis. Therefore, good glycemic control, especially in patients with liver disease, is of major importance.

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  1. Innere Medizin, Department I, Universitätsklinik Innsbruck, Innsbruck, Österreich

    Claudia Ress PhD

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Ress, C. Diabetes mellitus bei Patient:innen mit Leberzirrhose – eine besondere therapeutische Herausforderung. J. Gastroenterol. Hepatol. Erkr. (2024). https://doi.org/10.1007/s41971-024-00191-6

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