Factors Associated with Improved Glycemic Control by Direct-Acting Antiviral Agent Treatment in Egyptian Type 2 Diabetes Mellitus Patients with Chronic Hepatitis C Genotype 4

Abstract

BackgroundThe association of chronic hepatitis C virus (HCV) infection with type 2 diabetes mellitus (T2DM) was first reported in 1994. Little is known about the effect of direct-acting antiviral agents (DAAs) on glycemic control in T2DM patients. The aim of the present study was to evaluate the factors associated with improved glycemic control (IGC) by DAA treatment in Egyptian T2DM patients with chronic HCV genotype 4 infection.MethodsThis study included 460 T2DM patients with chronic HCV genotype 4 infection. Four hundred patients received DAAs and 60 patients did not receive DAAs. Patients with sustained virological response after 3 months of DAAs (378 patients) were allocated into two groups: first group included 292 patients (77.2%) with IGC and second group included 86 patients (22.8%) with non-improved glycemic control (NIGC).ResultsIn IGC group, 78 patients (26.7%) needed to decrease the dose of antidiabetic treatment. There were no significant differences between IGC and NIGC groups as regards age, sex, and body mass index. The percentage of patients with positive family history of T2DM, those with Child B class and duration of T2DM were significantly higher in NIGC group compared to IGC.ConclusionDiabetic patients receiving DAAs should be closely monitored for reduction of antidiabetic drugs especially insulin and sulfonylurea to avoid hypoglycemic events. Improvement of glycemic control with DAAs is more in patients without family history of T2DM, short duration of diabetes mellitus, and mild liver disease.

The effect of sustained virological response by direct-acting antivirals on insulin resistance and diabetes mellitus in patients with chronic hepatitis C

“…SVR induced a significant improvement in glycemic control, despite a significant weight gain and in 20.7% of SVR patients caused in a reduction or discontinuation of antidiabetic therapy [10] Similar data have been reported in a large Egyptian study comprising HCV genotype 4-infected patients treated with DAAs [11]. Patients with improved glycemic control needed a reduction in antidiabetic drugs and insulin dose; the family history of diabetes, the presence of Child B cirrhosis, and the duration of diabetes were associated with non-improvement in glycemic control.…”

Risk of diabetes in HIV‐infected patients is associated with cirrhosis but not with chronic HCV coinfection in a French nationwide HIV cohort

“…Finally, as this study was performed before widespread access to direct‐acting anti‐viral (DAA) treatments, the overall rate of SVR was low (17.4%). Several studies have shown that HCV clearance by DAA treatments improves IR in patients with mild liver fibrosis but not in patients with advanced liver fibrosis . Therefore, prospective studies should be conducted to assess the impact of early treatment of HCV infection, and of high rates of SVR with DAA treatments, on the occurrence of DM …”

Systematic review: chronic viral hepatitis and metabolic derangement

“…of patients had to decrease the dose of antidiabetic treatment because of better glycaemic control. 163 In addition, the improvement of insulin resistance is also observed in patients achieving SVR.…”

“…Additionally, for patients with T2DM, SVR leads to better glycaemic control at 12‐week post‐treatment than before DAA treatment is commenced . Dawood et al further indicated that 26.7% of patients had to decrease the dose of antidiabetic treatment because of better glycaemic control . In addition, the improvement of insulin resistance is also observed in patients achieving SVR.…”