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Liver disease and insulin altering drugs
Title: Frequency of liver disease in type 2 diabetic patients treated with oral antidiabetic agents
Author: S. Jick, et al.
Address: UK
Source: Diabetes Care 22: 2067-2071 (December) 1999
Summary: Researchers evaluated liver disease in conventionally treated type 2 diabetic patients to provide a reference against which reports of liver disease related to novel oral antidiabetic treatment could be compared. Patients with type 2 diabetes who were treated with oral antidiabetic agents were identified and were followed to determine whether they developed liver disease. Among 44,406 type 2 diabetic patients, 605 had a computer diagnosis of liver disease (incidence rate of 53.2/10,000 person-years). Of these, 186 had nonsymptomatic, mild and transient liver disorders; 249 had a predisposing condition; and 113 had another cause for the disease. A total of 57 cases were possibly drug induced (incidence rate 5.0/10,000person-years). Of the cases, 11 were attributed to other drugs, 8 to fatty liver disease of diabetes, and the remaining cases to uncertain causes. Oral antidiabetic agents were continued in 51 of these 57 cases, and researchers could not rule out oral antidiabetic agents as a cause of liver disease in 2 cases (incidence rate of 0.2/10,000 person-years). In this population, the background incidence of liver disease was high. Most cases involved other systemic diseases that may cause liver disease. The background rate of relatively mild liver disease (not due to oral antidiabetic treatment) in a population of type 2 diabetic patients is not uncommon and should be considered when evaluating spontaneous reports of liver disease in patients.
Comment: There has been considerable concern over liver disease in patients treated with insulin altering drugs such as troglitazone (Rezulen). This complication seems quite rare and to exclude these medications from therapy because of this potential complication may be unwarranted. A specific indication for therapy is needed and close monitoring is mandated.