The metabolic syndrome is a constellation of interrelated risk factors of metabolic origin—metabolic risk factors—that appear to directly promote the development of atherosclerotic cardiovascular disease. The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics commonly manifest a prothrombotic state and a pro-inflammatory state as well. Clinical implications of MetS should be focused on multifactorial interventions to reduce the risk of T2D. The increasing incidence of diabetes and related complications imposes a heavy health burden. Thus, investigations should focus on effective interventions and preventive measures for the disease.
Author(s) Details:
Adel Ekladious
Acute Medical Unit, Canberra Hospital, ACT Health, Australia, University of Western Australia, Australia and Australian National University, Australia.
Recent Global Research Developments in Glycogenic Hepatopathy in Diabetes Mellitus
Diagnostic Criteria and Clinical Presentation:
- GH is characterized by poorly controlled diabetes, acute liver injury (marked elevation in serum aminotransferases), and specific histological changes on liver biopsy.
- A 19-year-old type 1 diabetic female with recurrent diabetic ketoacidosis (DKA) presented with hepatomegaly and abnormal liver function tests.
- Liver biopsy revealed extensive glycogen accumulation in hepatocyte nuclei, confirming the diagnosis of GH [1].
Differentiating GH from NAFLD:
- NAFLD and GH share clinical similarities, making diagnosis challenging.
- NAFLD is increasingly common in T1D due to factors like overweight and obesity.
- GlyH, however, is rare but often seen in young individuals with extremely brittle metabolic control.
- Differentiating between NAFLD and GlyH is crucial, as NAFLD is associated with cardiovascular and kidney diseases, while GlyH is considered self-limiting [2].
Pathogenesis and Fibrosis:
- The exact pathogenesis of both hepatopathies remains unclear.
- Recent studies have identified varying degrees of fibrosis in GH, emphasizing the need for further research [3].
- Newer MRI protocols can help distinguish NAFLD from GlyH, aiding accurate diagnosis and management.
References
- Imtiaz, K. E., Healy, C., Sharif, S., Drake, I., Awan, F., Riley, J., & Karlson, F. (2013). Glycogenic hepatopathy in type 1 diabetes: an underrecognized condition. Diabetes care, 36(1), e6-e7.
- Mertens J, De Block C, Spinhoven M, Driessen A, Francque SM and Kwanten WJ (2021) Hepatopathy Associated With Type 1 Diabetes: Distinguishing Non-alcoholic Fatty Liver Disease From Glycogenic Hepatopathy. Front. Pharmacol. 12:768576. doi: 10.3389/fphar.2021.768576
- Sherigar, J. M., De Castro, J., Yin, Y. M., Guss, D., & Mohanty, S. R. (2018). Glycogenic hepatopathy: a narrative review. World journal of hepatology, 10(2), 172.
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