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Although there are no pharmacodynamic studies with acarbose in patients with hepatic insufficiency, its efficacy on hyperglycemia and its safety has been evaluated in patients with DM and CLD,39 alcoholic cirrhosis40 and mild hepatic encephalopathy.41 Its use was associated with a significant reduction of fasting and postprandial hyperglycemia, as well as HbA1c and C-peptide in diabetic patients with compensated cirrhosis.35 Biguanides: metformin Metformin is used to increase insulin sensitivity, and has beneficial effects on lipid metabolism