Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus

Abstract

Aim. To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM). Methods. We performed a retrospective case-control study in a viral hepatitis ambulatory clinic in Shreveport, Louisiana, during the period 11/01/2014 to 12/31/2017. All the clinic patient ages 18 years and above with treatment-naïve/biopsy-proven chronic hepatitis C and DM (hemoglobin A1C level≥6.5%) who were eligible for treatment were included in the study. Of 118 such patients, 59 were treated with oral DAAs for 8-12 weeks with the goal of achieving a sustained virologic response (SVR). A control group of 59 patients did not receive treatment for their hepatitis C and was followed in the clinic. Patients in the control group did not receive treatment either due to insurance issues or refusal of hepatitis C treatment. Results. Fifty-five of the 59 patients treated with DAAs (93%) achieved a SVR. Six months after treatment completion, their mean±SEM HbA1C level had decreased by 1.1±0.03% (P<0.0001). Four of the 59 patients treated with DAAs did not achieve a SVR. Their mean HbA1C 6 months after treatment completion had increased by 0.8±0.2%. Furthermore, there was no improvement in HbA1C levels over time in the untreated group (mean HbA1C increase, 0.2±0.05%; P<0.0001 vs. the treatment group, which had a mean HbA1C decrease of 0.9±0.2%). Conclusion. This controlled study demonstrated that treatment of chronic hepatitis C with DAAs results in statistically significant and meaningful reductions in hemoglobin A1C levels in patients with coexisting diabetic mellitus if a SVR is achieved.

Effect of HCV eradication by DAAs on liver steatosis, carotid atherosclerosis, and associated metabolic comorbidities: A systematic review

“…The independent predictors of glycemic amelioration in diabetic patients appear to be higher baseline HbA1c (>7%), viral eradication with DAAs, higher baseline alanine aminotransferase (ALT), lower aspartate aminotransferase (AST), and older age 62,75,83–86 . Conversely, higher fibrosis stage before treatment, longer T2DM duration, a positive family history of diabetes, the Child class B, and the oesophageal varices were associated with lower improvement of glycemic control 75,78,85,87 . Viral eradication seems to have the greater impact on the improvement of both HbA1c and HOMA‐IR in diabetic patients, whereas in prediabetic patients it is related only with the reduction of HbA1c 63,88 …”

Global longitudinal strain as a predictor of short-term effect of oral antiviral regimens on myocardium in Egyptian patients with chronic viral hepatitis C

“…Interestingly, an improvement in glycemic control during treatment with DAA therapy was reported by Dawood et al, who studied 460 patients with chronic HCV genotype-4-infection and type II DM, and showed that about 77% of patients with sustained virologic response after treatment with DAA achieved improvement in glycemic control by 3 months of treatment, and even about 26% of them needed to decrease their hypoglycemic agents' dose [24]. Also, in a recent study by Mada et al, that studied 118 diabetic patients with HCV who received DAA regimens, a significant and meaningful reduction in hemoglobin A1C levels was observed if sustained virologic response had achieved [25]. Such results may give a possible explanation to the neutralizing effect of DM on myocardium with DAA therapy.…”

Impact of sustained virologic response on glucose parameters among patients with chronic hepatitis C treated with direct-acting antivirals

“…Achievement of SVR has a proven beneficial impact on liver disease outcomes, reducing the risk of progression to cirrhosis, hepatic decompensation, hepatocellular carcinoma, liver transplantation, and death (5)(6)(7)(8)(9). However, the impact of HCV eradication on glucose metabolism disturbance is not so well defined (10)(11)(12)(13)(14)(15)(16)(17).…”

“…Also, compelling evidence indicates that SVR obtained with DAAs is associated with improvement in glycemic parameters, both in patients with and without a previous diagnosis of PDM or T2DM. However, glycemic improvement is not observed in all patients, and the baseline characteristics potentially linked to a higher likelihood of glycemic improvement after SVR remain undefined (10)(11)(12)(13)(14)(15)(16)(17).…”