Antidiabetic Treatments for Diabetes with Liver Cirrhosis

Diabetes is associated with about 30% of liver cirrhosis and affects prognosis, carcinogenesis, and the onset of complications. In cirrhosis, fasting normal and postprandial hyperglycemia are often present, and evaluation by glucose tolerance test or continuous blood glucose measurement is also considered. Although no treatment strategy has been established, if renal function is maintained, metformin will be the first choice, but for renal dysfunction cases and metformin ineffective cases, insulin will be indicated. Although the efficacy and safety of incretin-related drugs and sodium-glucose cotransporter 2 inhibitors have not been established, they can be expected to be effective in cases with obesity. On the viewpoint of preventing sarcopenia and hepatocarcinogenesis, antidiabetic drugs should be selected. Exogenous insulin should be indicated for patients with Child C grade. This review discusses antidiabetic treatments for diabetes with liver cirrhosis.