Diabetes mellitus in chronic hepatitis B and C: prevalence and potential association with the extent of liver fibrosis

Abstract

Diabetes mellitus has been reported to have an increased prevalence and to be associated with more severe fibrosis in patients with chronic hepatitis C. We evaluated the prevalence of diabetes mellitus in patients with chronic hepatitis B or C as well as the possible association between presence of diabetes and extent of liver fibrosis. In total, 434 consecutive patients with histologically documented hepatitis B e antigen (HBeAg)-negative chronic hepatitis B (n = 174) or chronic hepatitis C (n = 260) were studied. The relationships of diabetes and epidemiological, somatomorphic, laboratory and histological patient characteristics were evaluated. Liver histological lesions were blindly evaluated according to the Ishak's classification. Diabetes was present in 58 (13%) patients, without any difference between those with chronic hepatitis B (14%) or C (13%). Diabetes was observed significantly less frequently in patients with fibrosis score 0-2 (7.7%) than 3-4 (10.4%) than 5-6 (29.2%) (P < 0.001). The presence of diabetes was independently associated with higher gamma-glutamyl-transpeptidase (GGT) levels and more severe fibrosis or presence of cirrhosis (P < 0.001) as well as with presence of hepatic steatosis and increased serum triglycerides levels (P < 0.02). In the noncirrhotic patients, diabetes was significantly associated with older age and higher GGT levels, but not with the extent of fibrosis. In conclusion, diabetes mellitus is observed in more than 10% of patients with either HBeAg-negative chronic hepatitis B or chronic hepatitis C. The presence of diabetes is strongly associated with more severe liver fibrosis, but such an association may be related to the high prevalence of diabetes in patients with cirrhosis.

Clinical expression of insulin resistance in hepatitis C and B virus-related chronic hepatitis: Differences and similarities

“…Moreover, unlike other authors [16,[29][30][31][32] , we were able to measure, using these criteria, central obesity which is considered the fundamental condition for a clinical diagnosis of MS [33] . The association of diabetes and severe chronic liver disease is widely recognized [4,16,32,34] , therefore the effect of severe liver disease on diabetes onset should be considered when comparing groups of patients affected by chronic liver disease. In our study, we were able to rule out that diabetes was related to the altered hepatic glycaemic homeostasis due to severe liver disease (i.e.…”

“…In an attempt to shed light on this issue, we examined the prevalence of these phenomena in chronic hepatitis C (CHC) and in chronic hepatitis B (CHB) in order to distinguish between alterations due to presence of an advanced liver disease and those due to HCV [16][17][18] . We have investigated the prevalence of MS and/or diabetes and their effect on liver fibrosis and/or steatosis/steatohepatitis in a large cohort of patients affected by HCV-or hepatitis B virus (HBV)-related chronic hepatitis.…”

Hepatitis C is associated with type 2 diabetes mellitus in HIV‐infected persons without traditional risk factors

“…The association of HCV and type 2 DM is complex, with some studies suggesting that the higher prevalence of DM is a result of more severe liver disease in both the HCV-and hepatitis B virus (HBV)-infected groups [7,9,[13][14][15][16]. However, other studies have suggested that HCV may be directly involved in the development of type 2 DM or insulin resistance even in those without cirrhosis [8,[17][18][19] 491 HCV-infected persons over the age of 40 years in a nationwide cross-sectional study [11] and then in a longitudinal cohort study found that those with HCV infection were at increased risk for developing DM with increasing age and body mass index (BMI).…”

“…Secondly, longer duration of HIV-positive survival as a result of highly active antiretroviral therapy (HAART) leads to an older population which may contribute to the higher prevalence of DM, especially in those with HIV/HCV coinfection [4]. HCV itself has been linked to type 2 DM [5][6][7][8][9][10][11], and the higher prevalence of HCV in HIV-infected persons may also contribute to the increased prevalence of DM in the HIV-infected population [12].The association of HCV and type 2 DM is complex, with some studies suggesting that the higher prevalence of DM is a result of more severe liver disease in both the HCV-and hepatitis B virus (HBV)-infected groups [7,9,[13][14][15][16]. However, other studies have suggested that HCV may be directly involved in the development of type 2 DM or insulin resistance even in those without cirrhosis [8,[17][18][19] 491 HCV-infected persons over the age of 40 years in a nationwide cross-sectional study [11] and then in a longitudinal cohort study found that those with HCV infection were at increased risk for developing DM with increasing age and body mass index (BMI).…”

Role of Diabetes Mellitus in Liver Cirrhosis in the Anhui Region of China

“…Several studies have reported a high prevalence of DM among patients infected with HCV or HBV [3] [11] [17], and observations have indicated that diabetes occurs more frequently among HCV-infected patients than among HBV-infected patients. The results of this study also revealed that the incidence of DM was higher among patients with HCV-induced cirrhosis than among patients with HBV-induced cirrhosis.…”