Further evidence for an association between non-insulin-dependent diabetes mellitus and chronic hepatitis C virus infection

Abstract

Non-insulin-dependent diabetes mellitus (NIDDM) may be associated with chronic hepatitis C virus (HCV) infection. This was studied further in two parts. First, 1,151 patients with HCV-related cirrhosis and 181 patients with hepatitis B virus (HBV)-related cirrhosis, well matched for age, sex, and severity of cirrhosis, were reviewed retrospectively. The prevalence of diabetes mellitus was higher in HCV-related cirrhosis (23.6%) than in HBV-related cirrhosis (9.4%; odds ratio [OR], 2.78; 95% confidence interval [CI], 1.6-4.79; P ‫؍‬ .0002). The prevalence of diabetes mellitus was associated closely with the Child-Pugh score (OR, 3.83; 95% CI, 2.38-6.17; P F .0001) and increasing age (OR, 1.02; 95% CI, 1.00-1.03; P ‫؍‬ .0117). Second, 235 patients with biopsy confirmed chronic HBV or HCV underwent an oral glucose tolerance test. Only 1 of 70 patients with chronic viral hepatitis without cirrhosis was diabetic. However, 31 of 127 patients with HCV-related cirrhosis (24.4%) were diabetic compared with 3 of 38 patients with HBVrelated cirrhosis (7.9%, P ‫؍‬ .0477). The major variables associated with NIDDM were cirrhosis (OR, 14.39; 95% CI, 1.91-108; P ‫؍‬ .0096) and male sex (OR, 4.64; 95% CI, 1.32-16.18; P ‫؍‬ .0161). Fasting insulin levels in 30 patients with HCV-related cirrhosis and diabetes mellitus were elevated significantly, which was consistent with insulin resistance. However, acute insulin responsiveness was reduced in all patients with HCV infection and diabetes suggesting concomitant B-cell dysfunction. This study confirms an association between HCV and NIDDM. (HEPATOL-OGY 1999;30:1059-1063.)An association between cirrhosis and abnormalities of glucose metabolism has been recognized for over 20 years. 1

High prevalence of abnormal glucose homeostasis secondary to decreased insulin secretion in individuals with hereditary haemochromatosis

“…This may be a simple association based on the fact that exposure to high levels of iron for long periods may damage the liver and beta cell in parallel. Cirrhosis, hepatitis and hepatic iron overload are themselves, however, associated with insulin resistance [12,49]. Hramiak et al reported that in the absence of cirrhosis and diabetes, Si was normal in subjects with haemochromatosis [10].…”

Metabolic profiles in patients with chronic hepatitis C: a case–control study

“…Although a body of experimental data from in vitro cell cultures and in vivo transgenic mice support the existence of interaction between HCV and host metabolic factors, the results from clinical and epidemiological studies remained controversial [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. The inconsistencies may be due to small sample size, the selection of patients only from hospitals or limited to hepatitis patients with cirrhosis, with diabetes, or to post-liver-transplant.…”

Chronic hepatitis B viral infection independently predicts renal outcome in type 2 diabetic patients

“…Hence, glucose intolerance is common in patients with liver cirrhosis of whatever aetiology, and around 20% of cirrhotic patients have overt diabetes [3]. Chronic hepatitis C virus (HCV) infection is well known to be associated with increased risk of type 2 diabetes [4][5][6][7][8][9][10]. This risk association is independent of the presence of cirrhosis [11,12], and has been hypothesised to be mediated through insulin resistance and chronic inflammation [12].…”