Hypoglycemia in Diabetes Mellitus Patients with Liver Insufficiency—A Systematic Review

Liver insufficiency is a risk factor for hypoglycemia in patients without diabetes. However, the impact of chronic liver disease on hypoglycemia risk in people with diabetes remains unclear. The aim of this study was to systematically review existing literature on hypoglycemic events in diabetes patients with liver insufficiency. Using the words “diabetes” and “hypoglycemia”, “glycemic control”, “glucose measurement” and “liver insufficiency”, “chronic liver disease”, “cirrhosis”, “liver impairment”, “liver injury”, “liver failure”, “liver enzyme”, we searched Pubmed, Web of Science and Scopus databases for articles in English that contained data on hypoglycemia in diabetes patients with liver insufficiency published until the end of April 2024. A total of 19 studies involving a total of 100,000 patients with diabetes were included. Only two studies looked on the topic in more detail and both suggested hypoglycemia is more common in patients with both liver insufficiency and diabetes. Hypoglycemic events in these patients were often asymptomatic with its associated risks and often nocturnal. Remaining studies were of retrospective design with related limitations, but overall support the hypothesis. The risk of hypoglycemia especially asymptomatic in diabetes patients with liver insufficiency should be taken into account when treating these patients. A comparative study of diabetes patients with and without liver insufficiency is, however, missing.