A Case of Improved Insulin Resistance in Type 2 Diabetes After Liver Transplantation

Abstract

Recent studies have reported improvement of glycemic control following liver transplantation in patients with type 2 diabetes mellitus and chronic liver disease, and yet, the underlying mechanism is not well understood. In addition, the validity and effectiveness of such an approach in treating type 2 diabetes have not been addressed in the literature, mainly due to the limited amount of clinical data available. We report a case of patient whose insulin needs significantly reduced from 64 units per day to 0 in 2 years after liver transplantation. A 38 year-old woman had been initially diagnosed with liver cirrhosis; two years later, she was diagnosed with type 2 diabetes. And five years after the diagnosis, her glucose level was not adequately controlled despite the use of exogenous insulin. At the age of 48, liver transplantation was required due to intractable hepatic encephalopathy; since then, significant changes, as evidenced by fasting plasma-insulin and homeostasis model assessment insulin resistance index, have been observed. Therefore, the present case report provides additional data supporting that liver transplantation may alleviate type 2 diabetes in patients with concurrent chronic liver disease, presumably due to the change in insulin resistance, which appears to be a main underlying pathophysiologic feature of hepatogenous diabetes.