Other than Insulin Antidiabetic Treatment Associates with Better Status of Frailty in Patients with Cirrhosis and Type 2 Diabetes on Waiting List for Liver Transplantation

IF 3.8 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2025-09-01 DOI:10.1016/j.dld.2025.08.061

R. Vukotic , C. Sommovigo , G. Pratesi , S. Petruccelli , G. Cirillo , A. Trizzino , L. Petagna , E. Uruci , P. Carrai , D. Ghinolfi

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Abstract

Background and Aim

Frailty is demonstrated to affect outcomes of liver transplantation (LT) and is considered a modifiable risk factor on the waiting list (WL) through adequate screening for sarcopenia and pre-habilitation. The prevalence of sarcopenia in patients with both cirrhosis and type 2 diabetes (T2D) is uncertain. At present, there are no specific guidelines for the treatment of T2D in cirrhosis. Cirrhotic patients with T2D can be prescribed with most of the currently used antidiabetic strategies, but are mostly treated with insulin. The aim of the study was to explore whether there is a distinct frailty status across patients awaiting LT with T2D according to the choice of antidiabetic strategy.

Methods

From January 1st to December 31st 2024, one hundred seventy-six patients entering the WL for LT were consecutively enrolled to be screened for frailty assessment as to start the pre-habilitation program prior to LT.

Results

Thirty-eight patients placed on WL for LT had T2D. Among them, 25 were on other than insulin antidiabetic regimen (DPP-4i, GLP-1RA, SGLT-2) and 13 were on insulin. The dynamometer measure of the isometric grip force by hand grip strength (HGS) obtained in 3 attempts resulted higher in ‘other than insulin’ antiabetics treated patients than it those insulin-treated (HGS1 kg, 27 vs 23, p=.0244, HGS2 kg, 28 vs 24, p=.0355, HGS3 kg, 28 vs 24, p=.0131). Similar trend was observed for the percentile of frailty (48 vs 61, p=.0426), Sit-to-stand test, sec (9 vs 13, p=.0571), Liver Frailty Index (3.15 vs 4, p=.0408) and pseudocholinesterase, IU/L (4490 vs 2800, p=.0157).

Conclusions

In patients awaiting LT who are also affected by T2D, the antidiabetic regimens other than insulin might positively impact their status of frailty. Longitudinal studies exploring dynamic changes of frailty in patients on WL with T2D could help the identification of the best treatment options for T2D in this setting and highlight the potential benefits of frailty improvement on post-LT outcomes.

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非胰岛素治疗与等待肝移植的肝硬化和2型糖尿病患者较好的虚弱状态相关

背景和目的虚弱被证明会影响肝移植（LT）的结果，并且通过对肌肉减少症和预康复的充分筛查，被认为是等待名单（WL）上可改变的危险因素。肝硬化和2型糖尿病（T2D）患者中肌肉减少症的患病率尚不确定。目前，对于肝硬化患者的T2D治疗尚无具体的指南。肝硬化合并T2D的患者可以使用目前使用的大多数降糖策略，但主要是胰岛素治疗。该研究的目的是探讨根据抗糖尿病策略的选择，等待LT合并T2D的患者是否存在明显的虚弱状态。方法从2024年1月1日至12月31日，连续招募176例进入WL进行LT的患者，进行虚弱评估筛查，开始LT前的康复前计划。结果38例进入WL进行LT的患者有T2D。其中胰岛素外降糖方案（DPP-4i、GLP-1RA、SGLT-2） 25例，胰岛素组13例。通过3次试验获得的握力（HGS）测力仪测量的等距握力在“非胰岛素”治疗的患者中高于胰岛素治疗的患者（HGS1 kg, 27 vs 23, p= 0.0244, HGS2 kg, 28 vs 24, p= 0.055, HGS3 kg, 28 vs 24, p= 0.0131）。类似的趋势也出现在虚弱的百分位数（48比61，p= 0.0426），坐立测试，秒数（9比13，p= 0.071），肝脏虚弱指数（3.15比4，p= 0.0408）和假胆碱酯酶，IU/L（4490比2800，p= 0.0157）。结论对于合并T2D的等待LT患者，胰岛素以外的降糖方案可能对其虚弱状态有积极影响。通过纵向研究探索WL合并T2D患者虚弱度的动态变化，可以帮助确定这种情况下T2D的最佳治疗方案，并强调虚弱度改善对lt后预后的潜在益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.