Keywords :
Alanine aminotransferase, Alkaline phosphatase, Aspartate aminotransferase, Gammaglutamyltranspeptidase, Liver function tests, Type 2 diabetes mellitus
Citation Information :
Chilay A, Mehra N, Misra M, Jatale R, Ramchandran S. Liver Function Test and Diabetes Mellitus: Correlation from a Laboratory Perspective. Indian J Med Biochem 2023; 27 (2):40-44.
Aims and objectives: To study the correlation of LFTs with DM in the Indian population.
Background: Diabetes mellitus (DM) is a metabolic disorder characterized by increased blood glucose levels, resulting from defects in insulin secretion, insulin action, or both. Glucose is an important regulator of various pancreatic β-cell processes, including insulin biosynthesis and release. The liver plays an important role in glucose homeostasis. Evidence of deranged liver functions is observed in long-standing DM and a slight elevation of liver enzymes is seen in insulin resistance. Insulin resistance results in the production of free fatty acids which damage the liver parenchyma and result in elevation of the liver enzymes, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and gammaglutamyltranspeptidase (GGTP) in the serum.
Materials and methods: A retrospective analysis of 46,344 cases over a span of 3 years (2020–2022) was conducted in a referral laboratory in Mumbai. The patients included those who had tested for liver function tests (LFTs) [including SGPT, SGOT, ALP, GGTP, lactate dehydrogenase (LDH)], blood sugar (fasting and post lunch), and HbA1c.
Results: Overall 32.11% of the study population was diabetic. Among patients who had done glucose fasting, glucose postprandial, and HbA1c, 17.61% of patients were found to be diabetic at fasting, 15.76% at postprandial and 32.59% had elevated HbA1c levels. Maximum abnormality in LFT was observed in direct bilirubin (18.76%). Multiple logistic regression determined that abnormal ALP [odds ratio (OR): 1.4267, p < 0.0001], abnormal GGTP (OR: 1.87, p < 0.0001), and abnormal SGPT (ALT) (OR: 1.33, p < 0.0001) were independent associates with diabetes.
Conclusion: Long-standing or chronic diabetes due to its multisystem affection can adversely affect liver functions. Regulator monitoring of LFTs is essential in diabetic patients to avoid long-term complications.
Bora K, Borah M, Chutia H, et al. Presence of concurrent derangements of liver function test in type 2 diabetes and their relationship with glycemic status: A retrospective observational study from Meghalayal. J Lab Physicians 2016;8(1):30–35. DOI: 10.4103/0974-2727.176227.
Mathur S, Mehta DK, Kapoor S, et al. Liver function in type-2 diabetes mellitus patients. Int J Sci Study 3(10).
Raikwar V, Dangi V, Suran A. Liver function test parameters in patients having type 2 diabetes mellitus and hypertensive diabetes. Int J Med Res 23(1);2018:10–12.
Marchesini G, Bugianesi E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003; 37(4):917–923. DOI: 10.1053/jhep.2003.50161.
Shrestha N, Bhatt NP, Neopane P, et al. Hepatic involvement with elevated liver enzymes in Nepalese subjects with type 2 diabetes mellitus. Int J Biochem Res Rev 2017;16:1–8. DOI: 10.9734/IJBCRR/2017/31935.
Valarmathi A, Sastri L. Study of liver dysfunction in type 2 diabetic patients in private hospital in Cuddalore district. IAIM 2017;4(8):77–80.
Lui DT, Woo YC, Chow WS, et al. Glycogenic hepatopathy as an unusual etiology of deranged liver function in a patient with type 1 diabetes: A case report. Medicine 2019;98(17). DOI: 10.1097/MD.0000000000015296.
Siddiqa A, Khan S, Rafiq M, et al. Presence of concurrent derangements of liver function tests in type 2 diabetes: A retrospective observational study. TPMJ 2023;30(06):727–731. DOI: 10.29309/TPMJ/2023.30.06.7265.
Wang YL, Koh WP, Yuan JM, et al. Association between liver enzymes and incident type 2 diabetes in Singapore Chinese men and women. BMJ Open Diabetes Res Care 2016;4(1):e000296. DOI: 10.1136/bmjdrc-2016-000296.
Kocabay G, Telci A, Tutuncu Y, et al. Alkaline phosphatase: Can it be considered as an indicator of liver fibrosis in nonalcoholic steatohepatitis with type 2 diabetes? Bratisl Lek Listy 2011;112: 626–629. PMID: 22180989.
Mandal A, Bhattarai B, Kafle P, et al. Elevated liver enzymes in patients with type 2 diabetes mellitus and non-alcoholic fatty liver disease. Cureus 2018;10(11). DOI: 10.7759/cureus.3626.
Henry RM, Kostense PJ, Bos G, et al. Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn study. Kidney Int 2002;62:1402–1407. DOI: 10.1111/j.1523-1755.2002.kid571.x.
Kadi H, Ceyhan K, Sogut E, et al. Mildly decreased glomerular filtration rate is associated with poor coronary collateral circulation in patients with coronary artery disease. Clin Cardiol 2011;34:617–621. DOI: 10.1002/clc.20951.
Levy AS, Bosch JP, Lewis JB, et al. Modification of diet in renal disease study group. A more accurate method to estimate glomerular filtration rate from serum creatinine: A new prediction equation. Ann J Med 1999;130:461–470.
Westerbacka J, Corner A, Tamminen M, et al. Women and men have similar amounts of liver and intra-abdominal fat, despite more subcutaneous fat in women: Implications for sex differences in markers of cardiovascular risk. Diabetologia 2004;47(8):1360–1369. DOI: 10.1007/s00125-004-1460-1.
Jha SK, Yadav NK, Rizal S. Prevalence of elevated liver enzymes and its association with type 2 diabetes: A descriptive cross-sectional study among Nepalese adults from Biratnagar, Nepal. Asian J. Med. Sci 2021;12(6):50–55. DOI: https://doi.org/10.3126/ajms.v12i6.37074.
Shibabaw T, Dessie G, Molla MD, et al. Assessment of liver marker enzymes and its association with type 2 diabetes mellitus in Northwest Ethiopia. BMC Res Notes 2019;12(1):1–5. DOI: 10.1186/s13104-019-4742-x.
Bigagli E, Lodovici M. Circulating oxidative stress biomarkers in clinical studies on type 2 diabetes and its complications. Oxid Med Cell Longev 2019. DOI: https://doi.org/10.1155/2019/5953685.
Dundi VD, Pyadala N, Polavarapu R. Assessment of liver dysfunction among type 2 diabetic patients attending to a rural teaching hospital. J Biotechnol Biochem 2018;4(4):1–4.
Noroozi KM, Khalili P, Ayoobi F, et al. Serum liver enzymes and diabetes from the Rafsanjan cohort study. BMC Endocr Disord 2022;22(1):1–2. DOI: 10.1186/s12902-022-01042-2.
Salmela PI, Sotaniemi EA, Niemi M, et al. Liver function tests in diabetic patients. Diabetes Care 1984;7:248–254. DOI: 10.2337/diacare.7.3.248.
Balogun WO, Adeleye JO, Akinlade KS, et al. Frequent occurrence of high gamma-glutamyltransferase and alanine amino transferase among Nigerian patients with type 2 diabetes. Afr J Med Sci 2008;37:177–183. PMID: 18939403.
Grove J, Daly AK, Bassendine MF, et al. Association of a tumor necrosis factor promoter polymorphism with susceptibility to alcoholic steatohepatitis. Hepatology 1997;26:143–146. DOI: 10.1002/hep.510260119.