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    Home > Active Ingredient News > Endocrine System > When diabetes is combined with "abnormal liver function", how should hypoglycemic drugs be used?

    When diabetes is combined with "abnormal liver function", how should hypoglycemic drugs be used?

    • Last Update: 2022-04-29
    • Source: Internet
    • Author: User
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    This article is published by the author with the authorization of Yimaitong, please do not reprint without permission
    .

    Clinically, many diabetes patients are accompanied by abnormal liver function.
    When choosing hypoglycemic drugs, these patients must take into account both efficacy and safety to avoid further deterioration of liver function caused by drugs
    .

    How to choose hypoglycemic for diabetic patients with renal insufficiency has been discussed in the past.
    Today we will talk about how to choose hypoglycemic drugs when diabetes is complicated with abnormal liver function
    .

    1.
    What are the common causes of abnormal liver function in diabetic patients? To sum up, the abnormal liver function in diabetic patients mainly has the following reasons: patients with chronic liver disease (such as chronic viral hepatitis, etc.
    ); non-alcoholic fatty liver disease (NAFLD); alcoholic liver damage; drug-induced liver disease damage (eg, statins),
    etc.

     Among them, abnormal liver function caused by NAFLD is the most common
    .

    This is because: Type 2 diabetes and NAFLD share the same pathogenic basis - insulin resistance (IR), which can cause hyperinsulinemia and lipid metabolism disorders, and a large amount of fat accumulates in liver tissue, causing NAFLD and liver function.
    exception
    .

    According to statistics, the risk of NAFLD in patients with type 2 diabetes is 2 to 4 times that of ordinary people
    .

    It can be seen that there are many reasons for abnormal liver function, and the "pot" of abnormal liver function cannot be deducted from the hypoglycemic drugs
    .

    Second, how to assess the patient's liver function? According to the following five total scores to judge the classification, A grade has the best prognosis and C grade is the worst
    .

     Child-Pugh A (5-6 points) Child-Pugh B (7-9 points) Child-Pugh C (≥10 points) Table 1 Liver function classification (Child-Pugh) Liver damage? The liver is the most important digestive and metabolic organ in the human body.
    It has a wide variety of metabolic enzymes and is an important place for the metabolism of the three major substances (sugar, fat and protein).
    Many of the hypoglycemic drugs we usually eat are first metabolized by the liver.
    , and then excreted by the kidneys
    .

    When the patient's liver function is not good, it will inevitably affect the metabolism of drugs, thereby affecting the efficacy of drugs or increasing the adverse reactions of drugs
    .

     In general, various oral hypoglycemic drugs (including metformin) currently in clinical use are safe.
    However, after use, it may increase the metabolic burden of the patient's liver
    .

    Some patients refuse to eat due to choking, and they are afraid to take medicines because they are afraid of the side effects of the medicines, resulting in high blood sugar for a long time
    .

    In fact, the damage to the liver and kidney of patients with long-term hyperglycemia is far greater than the effect of drugs
    .

     4.
    Can diabetics with abnormal liver function only choose insulin? Insulin itself is a physiological hormone secreted by the human body, which does not damage the liver and kidney.
    Therefore, for diabetic patients with abnormal liver and kidney function, it is generally recommended to stop taking oral hypoglycemic drugs and switch to insulin therapy, but this is not absolute
    .

     As mentioned above, the abnormal liver function of many diabetic patients (especially obese patients with type 2 diabetes) is caused by the combination of NAFLD, which has a common pathogenesis basis with type 2 diabetes-insulin resistance (IR).
    Therefore, this If the liver damage is not particularly severe (transaminase does not exceed 2.
    5 times the upper limit of normal), oral hypoglycemic drugs with weight loss and insulin resistance improvement effects, such as biguanides, thiazolidinediones, and GLP-1, can be selected as appropriate.
    Receptor agonists, SGLT-2 inhibitors, etc.
    , can not only lower blood sugar, but also improve the therapeutic effect of liver function
    .

     5.
    How do diabetics with abnormal liver function choose oral hypoglycemic drugs? In addition to insulin, currently commonly used hypoglycemic drugs in clinical are mainly biguanides, sulfonylureas, glinides, α-glucosidase inhibitors, thiazolidinediones, SGLT-2 inhibitors, DPP-4 inhibitors , GLP-1 receptor agonists and other eight categories, each category has several species
    .

    How should these drugs be used in patients with abnormal liver function? 1.
    Metformin Metformin can reduce blood sugar, reduce body weight, improve insulin resistance, and it is not metabolized by the liver, and is mainly excreted by the kidneys as the prototype.
    Therefore, it can be used for patients with type 2 diabetes mellitus complicated by fatty liver and mild abnormal liver function
    .

    However, metformin increases lactate production and hepatic insufficiency reduces lactate clearance, so metformin is contraindicated in patients with liver function greater than 3 times the upper limit of normal
    .

    2.
    Sulfonylureas Sulfonylurea hypoglycemic drugs are mainly metabolized by the liver, and those with severe liver function abnormalities (transaminase exceeding 3 times the upper limit of normal) are prohibited
    .

    Patients with mild hepatic insufficiency can use it, but attention should be paid to starting with a small dose and gradually adjusting the dosage, and the liver function should be monitored regularly during the medication
    .

    3.
    Glinide 1) Repaglinide: it can be used in patients with mild abnormal liver function, with caution in patients with moderate abnormal liver function, and disabled in patients with severe abnormal liver function
    .

    2) Nateglinide: patients with mild to moderate liver disease can be used without dose adjustment, and patients with severe liver disease should be used with caution
    .

     4.
    Alpha-glucosidase inhibitors 1) Acarbose: There are few reports of acarbose-related liver injury, mild liver dysfunction is not a contraindication, and it is contraindicated in severe liver insufficiency or progressive elevation of liver enzymes
    .

    2) Voglibose: Due to the reports of fulminant hepatitis after voglibose was marketed, the liver function should be monitored when using voglibose, and the administration should be stopped when abnormality occurs, and appropriate treatment should be given
    .

     5.
    The thiazolidinediones and pioglitazone can increase the sensitivity of the liver to insulin and improve insulin resistance, and reduce the accumulation of fat in the internal organs.
    Therefore, it can be used for patients with type 2 diabetes and fatty liver
    .

    However, if the patient has active liver disease and transaminase exceeds 2.
    5 times the upper limit of normal, pioglitazone should not be taken
    .

    6.
    DPP-4 inhibitor 1) Sitagliptin: No dose adjustment is required for patients with mild to moderate hepatic impairment, and there is no medication experience for severe hepatic insufficiency, so it is not recommended
    .

    2) Saxagliptin: No dose adjustment is required for patients with mild or moderate hepatic impairment, and it is not recommended for patients with severe hepatic impairment
    .

    3) Alogliptin: No dose adjustment is required for patients with mild or moderate hepatic impairment
    .

    There is no clinical experience in patients with severe hepatic impairment
    .

    4) Linagliptin: Linagliptin is less metabolized in the body, and is mainly excreted in the feces in the original form through bile.
    Therefore, it can be used in mild, moderate and severe hepatic insufficiency without dose adjustment
    .

    5) Vildagliptin: It should not be used in patients whose transaminases exceed 3 times the upper limit of normal
    .

      7.
    SGLT-2 inhibitors can be used in mild to moderate hepatic insufficiency without dose adjustment.
    There are limited data in type 2 diabetic patients with severe hepatic insufficiency, and their use is not recommended
    .

    8.
    GLP-1 receptor agonists GLP-1 receptor agonists can act on adipocytes, inhibit hepatic lipogenesis, reduce hepatic steatosis, and are suitable for diabetic patients with fatty liver and mild to moderate abnormal liver function without the need for Adjust the dose
    .

    In conclusion, whether a diabetic patient with abnormal liver function can choose oral hypoglycemic drugs depends on the specific condition of the patient.
    etc.
    ) can be used, and not only will not affect liver function, but will improve liver function
    .

    However, if it is combined with chronic viral hepatitis (active stage) and liver cirrhosis, it is best to choose insulin in principle
    .

    In addition, pay attention to select oral hypoglycemic drugs that are not metabolized by the liver as much as possible
    .

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