Marked improvement in glycaemic control in a type 2 diabetes patient following a liver transplant for cirrhotic steatohepatitis

We present the case of a 58‐year‐old woman with poorly controlled, insulin‐treated type 2 diabetes mellitus who underwent a liver transplant for cirrhosis due to non‐alcoholic fatty liver disease complicated by encephalopathy and portal hypertension. Within four months of surgery she exhibited marked improvement in insulin sensitivity, as evidenced by reduced exogenous insulin requirement, with cessation of insulin therapy at 11 months and a consequent dramatic improvement in glycaemic control, eventually achieving an optimal glycosylated haemoglobin concentration on no specific diabetes treatment aside from dietary advice. This was despite a standard regimen of immunosuppressive treatments including prednisolone, tacrolimus and sirolimus which all have the propensity to induce insulin resistance. This case provides an interesting insight into the cause and effect of insulin resistance in the setting of non‐alcoholic fatty liver disease. Copyright ©2009 John Wiley & Sons.