Effect of treatment with direct antiviral agents (DAAs) on glycemic control in patients with type 2 diabetes mellitus & hepatitis C virus genotype 4

Over time evaluation of glycaemic control in direct‐acting antiviral‐treated hepatitis C virus/diabetic individuals with chronic hepatitis or with cirrhosis

“…However, contrasting data are available in this field, because the studies performed so far show substantial differences in the enrolled patient populations and limited durations of the post‐DAA‐treatment follow up. 29 , 30 Our study showed that subjects with chronic hepatitis had a significant and persistent amelioration of the glycaemic control and antidiabetic therapy could even be stopped in four patients. On the contrary, patients with compensated cirrhosis showed only a transient improvement, with a HbA1c rebound to pretreatment values 1 year after stopping DAA therapies.…”

“…A major question arising is whether HCV elimination might have any effect on metabolic control in T2DM patients. However, contrasting data are available in this field, because the studies performed so far show substantial differences in the enrolled patient populations and limited durations of the post‐DAA‐treatment follow up 29,30 . Our study showed that subjects with chronic hepatitis had a significant and persistent amelioration of the glycaemic control and antidiabetic therapy could even be stopped in four patients.…”

“…However, contrasting data are available in this field, because the studies performed so far show substantial differences in the enrolled patient populations and limited durations of the post-DAA-treatment follow up. 29,30 Our study showed that subjects with chronic hepatitis had a significant and persistent amelioration of the glycaemic control and antidiabetic therapy could even be stopped in four patients. On the contrary, patients with compensated cirrhosis TA B L E 2 Liver biochemistry and liver stiffness in CHC and cirrhotic subjects at baseline and at the end of follow up (120 weeks after stopping DAA treatment) 'toxic' effect on pancreatic islets are all suggested mechanisms determining an impairment of glucose metabolism in patients with liver cirrhosis, thus potentially contributing to the lack of long-term metabolic benefits of DAA treatment observed in these subjects.…”

“…However, contrasting data are available in this field, because the studies performed so far show substantial differences in the enrolled patient populations and limited durations of the post-DAA-treatment follow up. 29,30 Our study showed that subjects with chronic hepatitis had a significant and persistent amelioration of the glycaemic control and antidiabetic therapy could even be stopped TA B L E 2 Liver biochemistry and liver stiffness in CHC and cirrhotic subjects at baseline and at the end of follow up (120 weeks after stopping DAA treatment) TA B L E 3 Logistic regression analyses of different variables according to glucose control (HbA1c < 7.2) at 120 weeks after the end of DAA treatment in 182 HCV/ diabetic patients might argue that the reduction of the chronic inflammation levels may have had a positive impact on diabetes control in the short run, independently of the degree of liver damage. [32][33][34] Of note, a transient benefit of HCV extrahepatic manifestation was very recently reported in HCV patients with cutaneous psoriasis who had a dramatic amelioration of cutaneous lesions under DAA treatment, but almost all the cases showed a similarly dramatic worsening of their skin disease, which-24 weeks after stopping treatment-returned comparable with the basal time.…”

Therapy of Chronic Viral Hepatitis: The Light at the End of the Tunnel?

“…However, recent data suggested a direct role of HCV [172] by inducing death of pancreatic beta cells and upregulating several hepatokines known to cause insulin resistance. Achieving SVR by DAAs is associated with a reduced incidence of DM and a significant improvement in glycemic control among diabetic patients [93,[173][174][175][176][177] (Table 2, [178][179][180][181][182][183][184][185][186][187]). Moreover, this beneficial effect seems to have a clinical impact on DM-related complications [161].…”