[acb-diabetics] Elevated liver function in type 2

[Nancy Matulis]

http://clinical.diabetesjournals.org/content/23/3/115.full


Elevated Liver Function Tests in Type 2 Diabetes
Elizabeth H. Harris, MD
 
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Abstract
IN BRIEF
Individuals with type 2 diabetes have a higher incidence of liver function test abnormalities than individuals who do not have diabetes. Mild chronic elevations of transaminases often reflect underlying insulin resistance. Elevation of transaminases within three times the upper limits of normal is not a contraindication for starting oral antidiabetic or lipid-modifying therapy. In contrast, antidiabetic agents have generally been shown to decrease alanine aminotransferase levels as tighter blood glucose levels are achieved.
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Liver function tests (LFTs) are commonly used in clinical practice to screen for liver disease, monitor the progression of known disease, and monitor the effects of potentially hepatotoxic drugs.
The most common LFTs include the serum aminotransferases, alkaline phosphatase, bilirubin, albumin, and prothrombin time. Aminotransferases, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), measure the concentration of intracellular hepatic enzymes that have leaked into the circulation and serve as a marker of hepatocyte injury. Alkaline phosphatase (AP), γ-glutamyl transpeptidase (GGT), and bilirubin act as markers of biliary function and cholestasis. Albumin and prothrombin reflect liver synthetic function.
The aminotransferases AST and ALT are normally < 30-40 units/l. Elevations of aminotransferases greater than eight times the upper limit of normal reflect either acute viral hepatitis, ischemic hepatitis, or drug- or toxin-induced liver injury. Much more common than patients with acute hepatitis, however, are patients with chronic mild elevation of aminotransferases, or AST and ALT < 250 units/l for > 6 months.
Chronic mild elevation of transaminases are frequently found in type 2 diabetic patients. This article will provide a review of the pathology, incidence, causes, and drug therapy related to type 2 diabetic patients with elevated LFTs.

Nancy Matulis
Community Volunteer
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