Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct‐acting antiviral agents

Abstract

Many studies showed insulin resistance amelioration in HCV-patients achieving Sustained Virologic Response (SVR) but results on glycemic control in diabetic patients are unclear. This study aimed to assess fasting glucose (FG) and glycated hemoglobin (HbA1c) values before and after therapy with direct-acting antivirals (DAAs) in HCV-patients with type 2 diabetes mellitus (T2DM). Of the 122 consecutively recruited patients with chronic hepatitis C and T2DM, 110 patients were treated with DAAs and 12 remained untreated. Clinical, biochemical, virological, and metabolic features were collected both at baseline and at 12 weeks after the end of therapy (EOT) or after a comparable period of time in untreated patients. A total of 101 patients obtained a SVR (Group 1), while nine were relapsers. Group 2 (21 patients) was composed by the nine relapsers and the 12 untreated patients. A significant reduction of mean FG (134.3 ± 41.32 mg/dL vs 152.4 ± 56.40 mg/dL, P = 0.002) and HbA1c values (46.51 ± 16.15 mmoL/moL vs 52.15 ± 15.43 mmoL/moL, P < 0.001) was found in Group 1 but not in Group 2 (140.6 ± 47.87 mg/dL vs. 145.31 ± 30.18 mg/dL, P = 0.707, and 55.31 ± 20.58 mmoL/moL vs. 53.38 ± 9.49 mmoL/moL, P = 0.780). In Group 1, 20.7% of patients could reduce or suspend their antidiabetic therapy compared to none in Group 2 (P = 0.03), despite the significant weight increase observed in Group 1. SVR induced a significant amelioration of glycemic control in diabetic HCV-patients, despite a significant weight increase; larger prospective studies are needed to verify whether these results are maintained over the long-term.

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

“…An Italian study [10] aimed at the evaluation of fasting glucose and glycated hemoglobin values before and after DAA therapy in HCV patients with T2DM confirms the results of the previous study by strengthening the close link between HCV and diabetes. 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].…”

“…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.…”

“…Based on these data, it has been suggested that diabetic patients treated with DAAs should be carefully monitored in the short time to reduce antidiabetic drugs in order to avoid hypoglycemic episodes [10].…”

Benchmarks of Diabetes Care in Men Living With Treated HIV-Infection: A Tertiary Center Experience

“…HCV co-infection is associated with peripheral insulin resistance and poor glucose control in diabetes (44). Current pharmacotherapy for HCV using Sofosbuvir and Velpatasvir as shown high rates of virus eradication (45) and improved glucose control (46, 47). Therefore, people with HCV co-infection should be offered access to HCV eradication.…”

Real‐world effectiveness and safety of ledipasvir/sofosbuvir for genotype 6 chronic hepatitis C patients in Taiwan

“…The HbA1c level fell shortly after LDV/SOF. The results in this study revealed a decline of HbA1c in both DM and non‐DM patients following the SVR, indicating that better sugar control may be a favorable result of successful DAA treatment in CHC patients . However, parameters associated with insulin, insulin resistance, and beta‐cell function remained unchanged in this study.…”