Glucose intolerance and insulin resistance in cirrhosis are normalized after liver transplantation

Abstract

Cirrhosis is often associated with insulin resistance and glucose intolerance. We evaluated if these alterations are restored by liver transplantation (LT). Glucose tolerance (oral glucose tolerance test [OGTT]), peripheral insulin sensitivity (euglycemic insulin clamp technique), glucose oxidation (indirect calorimetry), nonoxidative glucose disposal, and insulin secretion (hyperglycemic clamp technique) were measured in 6 patients (Group 1) before and 6 months after LT, in 12 patients (Group 2) who underwent LT 6 to 30 months previously, and in 6 healthy individuals (controls). In Group 1, glucose tolerance and insulin sensitivity (3.24 ± 0.37 mg/kg/min) were normalized after LT (8.6 ± 0.77 mg/kg/min; P < .0001; P = not significant vs. controls). The improved insulin-mediated glucose uptake was the result of a normalization of nonoxidative glucose disposal. Fasting insulin and C-peptide decreased from 24.6 ± 3.3 μU/mL and 4.37 ± 0.46 ng/dL, respectively, to 12.7 ± 1.9 μU/mL and 2.46 ± 0.5 ng/dL (controls: 10.0 ± 3 μU/mL and 1.45 ± 0.34 ng/dL). The glucose-induced increase of insulin concentration, which was higher before LT, showed a significant reduction, although the first phase of β-cell secretion remained significantly higher compared with that of controls. All these findings were also confirmed in Group 2. The present data indicate that LT normalizes glucose tolerance and insulin sensitivity in cirrhotic patients through an improvement of both hepatic glucose clearance and the peripheral glucose disposal. The latter effect may be the result of the correction of chronic hyperinsulinemia. An increased first-phase β-cell insulin secretion in response to high glucose levels persists, suggesting that a memory of previous insulin resistance is maintained.