<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2341-4545</journal-id>
<journal-title><![CDATA[GE-Portuguese Journal of Gastroenterology]]></journal-title>
<abbrev-journal-title><![CDATA[GE Port J Gastroenterol]]></abbrev-journal-title>
<issn>2341-4545</issn>
<publisher>
<publisher-name><![CDATA[Sociedade Portuguesa de Gastrenterologia]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2341-45452025000400016</article-id>
<article-id pub-id-type="doi">10.1159/000541211</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Disorder of Glucose Metabolism and Therapy: Implications on the Natural History of Advanced Chronic Liver Disease]]></article-title>
<article-title xml:lang="pt"><![CDATA[Perturbação do metabolismo da glicose e terapêutica: implicações na história natural da doença hepática crónica avançada]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Soares]]></surname>
<given-names><![CDATA[So&#64257;a Garcês]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Frazão]]></surname>
<given-names><![CDATA[Tereza]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Tuna]]></surname>
<given-names><![CDATA[Célia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montes]]></surname>
<given-names><![CDATA[Margarida]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rocha]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Santos]]></surname>
<given-names><![CDATA[Lígia Rodrigues]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carrola]]></surname>
<given-names><![CDATA[Paulo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Carvalho]]></surname>
<given-names><![CDATA[Sónia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pinho]]></surname>
<given-names><![CDATA[Inês]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nogueira]]></surname>
<given-names><![CDATA[Luís]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Marques-Cruz]]></surname>
<given-names><![CDATA[Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Presa]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Unidade Local de Saúde Tâmega e Sousa Internal Medicine Department ]]></institution>
<addr-line><![CDATA[Pena&#64257;el ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Unidade Local de Saúde Alto Ave Internal Medicine Department ]]></institution>
<addr-line><![CDATA[Guimarães ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Unidade Local de Saúde Cova da Beira Internal Medicine Department ]]></institution>
<addr-line><![CDATA[Covilhã ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Unidade Local de Saúde Trás-os Montes e Alto Douro Internal Medicine Department ]]></institution>
<addr-line><![CDATA[Vila Real ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Unidade Local de Saúde Gaia e Espinho Internal Medicine Department ]]></institution>
<addr-line><![CDATA[Vila Nova de Gaia ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Unidade Local de Saúde Trás-os-Montes e Alto Douro Internal Medicine Department Liver Unit]]></institution>
<addr-line><![CDATA[Vila Real ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,University of Porto Faculty of Medicine Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS)]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af8">
<institution><![CDATA[,Local Health Unit of Trás-os-Montes e Alto Douro Public Health Unit ]]></institution>
<addr-line><![CDATA[Vila Real ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<volume>32</volume>
<numero>4</numero>
<fpage>16</fpage>
<lpage>24</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2341-45452025000400016&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2341-45452025000400016&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2341-45452025000400016&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Hepatogenous diabetes (HD) is a disorder of glucose metabolism (DGM) that develops as a complication of advanced chronic liver disease (ACLD) with an estimated prevalence of 20-70%. It appears to be associated with a larger number of decompensations, but its impact on the natural history of the disease is unclear. The treatment of DGM is hampered by the fact that some therapeutic agents are associated with a risk of complications in ACLD. The aim of this work was to study DGM in a population of patients with ACLD: prevalence, liver disease decompensation episodes, mortality analysis and study of the impact of antidiabetic therapies in patients with ACLD who developed DGM.  Materials and Methods:  A cohort of consecutive patients with ACLD without previous DGM, who attended a Hepatology clinic in the period of January to June 2015 was selected. Follow-up was carried out for 5 years. Data on age, gender, date of diagnosis and etiology of ACLD, Child-Pugh and MELD-Na classi&#64257;cations at enrollment, development of DGM, and antidiabetic therapy were collected. Logistic regression models for hospitalizations due to decompensated ACLD, ascites, hepatic encephalopathy (HE), upper gastro-intestinal bleeding (UGB), hepatocellular carcinoma (HCC), portal vein thrombosis (PVT), infectious complications, acute-on-chronic liver failure (ACLF), and death were built. A survival analysis for patients with and without DGM was also performed. Treatment effectiveness for patients with DGM was assessed.  Results:  Initially, 221 patients were included, 154 (69.7%) of whom developed DGM after the diagnosis of ACLD. DGM patients presented a signi&#64257;cantly higher number of hospitalizations. Odds ratio (OR) for death was not signi&#64257;-cantly related with DGM. At 5 years of follow-up, 68.9% of patients with DGM were alive, against 81.8% without DGM (p = 0.087). From the 154 patients who were diagnosed with DGM, 42.9% were not receiving pharmacological treatment for DGM. Treated patients were prescribed with either biguanides (34.8%), a SGLT2 inhibitor (8.6%), or insulin (7.7%). Only 1 patient was treated with a GLP-1 analogue. A tendency of OR favoring treatment was observed for biguanides and SGLT2 inhibitors in all outcomes except ascites. In the univariable analysis, the use of biguanides was associated with lower risk of death (OR: 0.84 [95% CI: 0.73-0.96]) and HE (OR: 0.85 [95% CI: 0.73-0.98]).  Conclusion:  DGM occurs with high prevalence in patients with ACLD and it seems to be related to more hospitalizations, which highlights the importance of its early identi&#64257;cation and appropriate therapeutic approach. In the absence of contraindications, biguanides should be considered for treatment of patients with ACLD and DGM as they appear to be associated with a tendency to better outcomes and may present some advantage in terms of survival.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A Diabetes hepatogénica é uma perturbação do metabolismo da glicose (PMG) que se desenvolve como complicação da doença hepática crónica avançada (DHCA) com uma prevalência estimada de 20-70%. Parece estar associada a um maior número de descompensações, mas o seu impacto na história natural da doença não é claro. O tratamento da PMG é di&#64257;cultado pelo facto de alguns agentes terapêuticos estarem associados a um risco de complicações na DHCA. O objetivo deste trabalho é estudar a PMG numa população de doentes com DHCA: prevalência, descompensações, análise de mortalidade e estudar o impacto de diferentes terapêuticas antidiabéticas em pacientes com DHCA que desenvolveram PMG.  Materiais e Métodos:  Foi selecionada uma coorte de doentesconsecutivoscom DHCA esem PMGprévia, seguidos em consulta de Hepatologia no período de Janeiro a Junho de 2015. O seguimento foi efetuado durante 5 anos. Foram colhidos dados sobre idade, sexo, data de diagnóstico e etiologia da DHCA, classi&#64257;cações de Child-Pugh e MELD-Na no recrutamento, desenvolvimento de PMG e terapêutica anti-diabética. Foram construídos modelos de regressão logística para as hospitalizações por descompensação de DHCA, ascite, encefalopatia hepática (EH), hemorragia digestiva alta (HDA), carcinoma hepatocelular (CHC), trombose da veia porta (TVP), complicações infeciosas, ACLF e morte. Foi efectuada uma análise de sobrevivência para doentes com e sem PMG. Foi avaliada a e&#64257;cácia do tratamento de pacientes com PMG.  Resultados:  Inicialmente, foram incluídos 221 doentes, 154 (69.7%) dos quais desenvolveram PMG após o diagnóstico de DHCA. A população PMG apresentou um número signi&#64257;cativamente maior de hospitalizações. A odds ratio para morte não estava estatisticamente relacionada com a PMG. Aos 5 anos de seguimento, 68.9% dos pacientes com PMG estavam vivos versus 81.8% dos pacientes sem PMG (p =0.087). Dos 154 pacientes que foram diagnosticados com PMG, 42.9% dos pacientes não estavam sob tratamento farmacológico para a PMG. Aos pacientes tratados foram prescritas biguanidas (34.8%), um inibidor SGLT2 (8.6%) ou insulina (1.1%). Apenas 1 paciente foi tratado com um análogo GLP-1. Foi observada uma tendência de odds ratio a favorecer o tratamento para todos os resultados para as biguanidas e para os inibidores SGLT2 à excepção da ascite. Na análise univariável, o uso de biguanidas estava associado a menor risco de morte (OR: 0.84 [95% CI: 0.73-0.96]) e de EH (OR 0.85 [95% CI: 0.73-0.98]).  Conclusão:  A PMG ocorre com elevada prevalência em pacientes com DHCA e parece estar relacionada com mais internamentos, o que destaca a importância da sua identi&#64257;cação precoce e abordagem terapêutica adequada. Na ausência de contraindicações, as biguanidas devem ser consideradas para tratamento de pacientes com DHCA e PMG, porque parecem estar associadas aumatendênciaparamelhoresresultados e podem apresentar alguma vantagem em termos de sobrevivência.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Hepatogenous diabetes]]></kwd>
<kwd lng="en"><![CDATA[Glucose intolerance]]></kwd>
<kwd lng="en"><![CDATA[Chronic liver disease]]></kwd>
<kwd lng="en"><![CDATA[Biguanides]]></kwd>
<kwd lng="pt"><![CDATA[Diabetes hepatogénica]]></kwd>
<kwd lng="pt"><![CDATA[Intolerância à glicose]]></kwd>
<kwd lng="pt"><![CDATA[Doença hepática crónica]]></kwd>
<kwd lng="pt"><![CDATA[Biguanidas]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Orsi]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Grancini]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Menini]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Aghemo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Pugliese]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatogenous diabetes: is it time to separate it from type 2 diabetes?]]></article-title>
<source><![CDATA[Liver Int]]></source>
<year>2017</year>
<volume>37</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>950-62</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatogenous diabetes: an underestimated problem of liver cirrhosis]]></article-title>
<source><![CDATA[Indian J Endocrinol Metab]]></source>
<year>2018</year>
<volume>22</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>552-9</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[García-Compeán]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[González-González]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Lavalle-González]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
<name>
<surname><![CDATA[González-Moreno]]></surname>
<given-names><![CDATA[EI]]></given-names>
</name>
<name>
<surname><![CDATA[Villarreal-Pérez]]></surname>
<given-names><![CDATA[JZ]]></given-names>
</name>
<name>
<surname><![CDATA[Maldonado-Garza]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatogenous diabetes: is it a neglected condition in chronic liver disease?]]></article-title>
<source><![CDATA[World J Gastroenterol]]></source>
<year>2016</year>
<volume>22</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>2869-74</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Coman]]></surname>
<given-names><![CDATA[LI]]></given-names>
</name>
<name>
<surname><![CDATA[Coman]]></surname>
<given-names><![CDATA[OA]]></given-names>
</name>
<name>
<surname><![CDATA[Badarau]]></surname>
<given-names><![CDATA[IA]]></given-names>
</name>
<name>
<surname><![CDATA[Paunescu]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Ciocîrlan]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Association between liver cirrhosis and diabetes mellitus: a review on hepatic outcomes]]></article-title>
<source><![CDATA[J Clin Med]]></source>
<year>2021</year>
<volume>10</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>262</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Vasepalli]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Noor]]></surname>
<given-names><![CDATA[MT]]></given-names>
</name>
<name>
<surname><![CDATA[Thakur]]></surname>
<given-names><![CDATA[BS]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatogenous diabetes - a report from Central India]]></article-title>
<source><![CDATA[J Clin Exp Hepatol]]></source>
<year>2022</year>
<volume>12</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>312-8</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nath]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Anand]]></surname>
<given-names><![CDATA[AC]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Hepatogenous diabetes: a primer]]></article-title>
<source><![CDATA[J Clin Exp Hepatol]]></source>
<year>2021</year>
<volume>11</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>603-15</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<collab>American Diabetes Association Professional Practice Committee</collab>
<article-title xml:lang=""><![CDATA[2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2022.]]></article-title>
<source><![CDATA[Diabetes Care]]></source>
<year>2022</year>
<volume>45</volume>
<numero>^sSuppl 1</numero>
<issue>^sSuppl 1</issue>
<supplement>Suppl 1</supplement>
<page-range>S17-38</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Elkrief]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Rautou]]></surname>
<given-names><![CDATA[PE]]></given-names>
</name>
<name>
<surname><![CDATA[Sarin]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Valla]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Paradis]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Moreau]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diabetes mellitus in patients with cirrhosis: clinical implications and management]]></article-title>
<source><![CDATA[Liver Int]]></source>
<year>2016</year>
<volume>36</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>936-48</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[García-Compeán]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Jáquez-Quintana]]></surname>
<given-names><![CDATA[JO]]></given-names>
</name>
<name>
<surname><![CDATA[González-González]]></surname>
<given-names><![CDATA[JA]]></given-names>
</name>
<name>
<surname><![CDATA[Lavalle-González]]></surname>
<given-names><![CDATA[FJ]]></given-names>
</name>
<name>
<surname><![CDATA[Villarreal-Pérez]]></surname>
<given-names><![CDATA[JZ]]></given-names>
</name>
<name>
<surname><![CDATA[Maldonado-Garza]]></surname>
<given-names><![CDATA[HJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La diabetes en la cirrosis hepática (Diabetes in liver cirrhosis).]]></article-title>
<source><![CDATA[Gastroenterol Hepatol]]></source>
<year>2013</year>
<volume>36</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>473-82</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
