Original Article Insulin resistance and plasma glucose tolerance abnormalities in Nigerians with chronic liver disease Oluwadamilola O. Amjo a, 1 , David O. Soyoye a, b, * , Ifeoluwa Amjo a, 1 , Olaoluwatomi T. Yusuff a , Babatope A. Kolawole a, b , Rosemary T. Ikem a, b , Olusegun Adekanle a, b , Dennis A. Ndububa a, b a Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria b Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria article info Article history: Received 15 May 2019 Accepted 21 May 2019 Keywords: Glucose intolerance Insulin resistance Liver disease abstract Aims: Glucose tolerance abnormalities are frequently observed in patients with chronic liver disease (CLD). Insulin resistance (IR) has been suggested to be a major factor responsible for these abnormalities in CLD. However studies relating IR with severity of CLD are scarce in Nigeria. This study assessed insulin resistance and glucose tolerance abnormalities in CLD and their relationship with the severity of CLD in a tertiary hospital in South-West, Nigeria. Methods: This cross sectional study involved 100 subjects with CLD. Ethical clearance was obtained and informed consent was granted by participants. Participants were interviewed using a structured pro- forma; physical examination and relevant investigations were performed. Insulin resistance was measured using the homeostasis model assessment (HOMA-IR) Data was analysed using Statistical Package for Social Sciences version 20.0 and p value of <0.05 was considered significant. Results: Mean age of the study participants was 51.9 ± 11.9 years, and mean duration of CLD was 15.9 ± 5.8 months. Glucose tolerance abnormalities were present in 66 subjects (66%) and increased from 16.1% in Child Pugh's class A to 90.0% in class C. HOMA-IR positively correlated with age, body mass index, serum blood glucose, duration and severity of CLD. Increasing age, presence of hepatocellular carcinoma, Child Pugh's class B and class C were asso- ciated with glucose tolerance abnormalities. Conclusion: Glucose tolerance abnormalities and insulin resistance were highly prevalent among chronic liver disease subjects studied and seemed to parallel the severity of CLD, determined by the Child Pugh's score. © 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved. 1. Introduction Glucose tolerance abnormalities (GTA) refer to a continuum of impaired fasting glucose, impaired glucose tolerance and type 2 diabetes mellitus, and they have evolved to become a global health problem especially in developing countries like Nigeria where westernisation, urbanisation and sedentary life are vital contribu- tors [1]. The pathogenesis and manifestations of these metabolic abnormalities are evident in most tissues and organs of the body. The liver plays an important role in carbohydrate metabolism and in the balance of blood glucose levels through glycogenolysis and gluconeogenesis, and this metabolic homeostasis may be impaired in chronic liver disease (CLD) due to disorders such as insulin resistance, glucose intolerance and diabetes [2,3]. Chronic liver disease is a disease of the liver resulting from an inflammatory, infiltrative, immunologic, circulatory or metabolic injury to the liver, a process which has been on-going for a period of time, usually about 6 months or longer without complete resolu- tion [4]. Chronic liver disease, like glucose tolerance abnormalities is a major global health problem with high morbidity and mortality, and may present as inflammation (chronic hepatitis), liver cir- rhosis(LC) and hepatocellular carcinoma(HCC) [4]. In Nigeria, the * Corresponding author. Department of Medicine, Obafemi Awolowo University, Ile-Ife, Nigeria. E-mail address: dosoyoye@oauife.edu.ng (D.O. Soyoye). 1 Present Address: Emergency Department, East Surrey Hospital, Redhill, Surrey, United Kingdom. Contents lists available at ScienceDirect Diabetes & Metabolic Syndrome: Clinical Research & Reviews journal homepage: www.elsevier.com/locate/dsx https://doi.org/10.1016/j.dsx.2019.05.014 1871-4021/© 2019 Diabetes India. Published by Elsevier Ltd. All rights reserved. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 13 (2019) 2208e2213