Liver dysfunction could influence plasma glucose homeostasis

Liver dysfunction could influence plasma glucose homeostasis. Several studies reveal that liver enzymes are not only markers of liver function test, but also could serve as predictive indicator of the severity of DM. The report correlation between fasting glucose and insulin level suggest that elevated blood glucose is associated with insulin resistance. Therefore, level of liver enzymes could be showing the dysfunctions of insulin secretion and break down (21). Because of this, our study shows the association between levels of liver enzymes in type 2 diabetic patients. In our study, we investigated 50 cases of type 2 DM for liver enzymes such as ALT, AST and GGT; and compared them with 50 non-diabetic subjects as controls. Serum ALT (34.46 ±15.39 Vs 20.33 ±7.77 P ?.000), serum AST (37.28 ± 15.97 Vs 18.99 ± 6.75 P? .000) and GGT (36±6 Vs 23±3.34 P? .000) were raised significantly in type 2 DM as compared to the control group. However, the mean values were placed within the normal range. In addition, our current study illustrated that however the mean level of ALT, AST, and GGT enzymes were within the normal range but we recognized that some values of these enzymes in the patients group more than the normal range (24% for ALT, 20% for AST, and 10% for GGT). Our findings agree with resent study in Iraq, were 115 diabetes patients and 50 healthy non diabetes subject as normal control were tested for major liver function ,although the mean of ALT and AST were falling within the normal range of the kit manufacturer but 28 % for ALT and 12 % for AST were more than the normal range (22). Likewise recent study in Myanmar, Singapore demonstrated that the mean value of ALT and AST were within the reference range among the diabetic patient. Increased ALT and AST were observed in 18.5% and 14.8 respectively in the patient group of the study (23). Similar finding was also present in India, were investigated 90 type 2 diabetes for liver enzyme ALT and 90-health control. Serum ALT (71.65+/-23.3) levels were raised significantly 36 (40%) in type 2 diabetic groups (13). Also our data is in agreement with study conducted in Sudan, covered 50 diabetes patients and 30 normal control subjects were tested for liver function, the means of ALT and AST were reported to be significantly higher in type 2 diabetes than the control group. Even if, the mean values were falling within the normal range. Overall 11 (22%) had at least one or more abnormal liver function test enzymes (20). Based on our study elevations of liver enzymes in type 2 diabetic patient will be because loss of insulin effect on the liver leads to glycogenolysis and an increased in hepatic glucose production. Thus due to increase substrate delivery (e.g., alanine) and an increased conversion of alanine to glucose. ALT might thus be up-regulated as a compensatory response to the impaired hepatic insulin signaling or, alternatively, may leak more easily out of the hepatocytes as a consequent of fatty infiltration and subsequent damage. Abnormalities of triglyceride storage and lipolysis in insulin-sensitive issues such as liver are an early manifestation of conditions characterized by insulin resistance and are detected early than fasting hyperglycemia. The excess in free fatty acid due to lipolysis found in insulin-resistance state is known to be directly toxic to hepatocytes. An accepted mechanism includes cell membrane disruption at high concentration, mitochondrial dysfunction, toxic formation and activation and inhibition of key steps in the regulation of metabolism (24). The above theories all attributes elevated transaminase to direct Hepatocytes injury. The most important limitation of our study includes the small study population and lack of invasive procedures like liver biopsy to better assess the liver structural change. Moreover, we did not follow up the patient to know further progress with different time duration.