Skip to main content
  • Original article
  • Open access
  • Published:

Diabetogenic effect of hepatitis C virus and insulin resistance among chronic hepatitis C patients

Abstract

Context

Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. In addition to established liver injury, type 2 diabetes mellitus is one of the most important extrahepatic metabolic disorders that are attributed to HCV infection.

Aim

The aim of this study was to investigate the impact of HCV infection in insulin resistance (IR).

Patients and methods

Our study included 100 patients with HCV who were divided into two groups according to the presence and absence of diabetes and 25 diabetic patients who served as a control group. They were subjected to full medical history and examination and laboratory investigations including high-sensitivity C-reactive protein (CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), fasting insulin, and fasting glucose.

Results

Our study showed increased IR among diabetic HCV-infected patients (group I) with a mean level of homeostasis model assessment of IR of 3.02, 1.457, and 1.064 in groups I, II, and III, respectively. There was also an increased level of proinflammatory cytokines (CRP, TNF-α, and IL-6) in this group, with mean levels of high-sensitivity CRP of 9.448, 7.7062, and 5.8229 mg/dl in groups I, II, and III, respectively. The mean level of IL-6 in group I was 215.63 pg/ml, in group II it was 167.62 pg/ml, and in group III it was 173.72 pg/ml. The mean level of TNF-α was 626.12, 618, and 422.76 pg/ml in groups I, II, and III, respectively, suggesting the role of proinflammatory cytokines in the pathogenesis of IR in chronic HCV.

Conclusion

HCV infection is associated with an increased level of proinflammatory cytokines that play a crucial role in the pathogenesis of IR in chronic HCV.

References

  1. Huang JF, Yu ML, Dai CY, Chuang WL, Chang WY. Glucose abnormalities in hepatitis C virus infection. Kaohsiung J Med Sci 2013; 29:61–68.

    Article  CAS  Google Scholar 

  2. El-Zayadi AR, Anis M. Hepatitis C virus induced insulin resistance impairs response to anti viral therapy. World J Gastroenterol 2012; 18:212–224.

    Article  Google Scholar 

  3. Deltenre P, Louvet A, Lemoine M, Mourad A, Fartoux L, Moreno C, et al. Impact of insulin resistance on sustained response in HCV patients treated with pegylated interferon and ribavirin: a meta-analysis. J Hepatol 2011; 55:1187–1194.

    Article  CAS  Google Scholar 

  4. Arase Y, Suzuki F, Suzuki Y, Akuta N, Kobayashi M, Kawamura Y, et al. Sustained virological response reduces incidence of onset of type 2 diabetes in chronic hepatitis C. Hepatology 2009; 49:739–744.

    Article  CAS  Google Scholar 

  5. Aghemo A, Prati GM, Rumi MG, Soffredini R, D’Ambrosio R, Orsi E, et al. Sustained virological response prevents the development of insulin resistance in patients with chronic hepatitis C. Hepatology 2012; 56: 1681–1687.

    Article  CAS  Google Scholar 

  6. Yudkin JS. Abnormalities of coagulation and fibrinolysis in insulin resistance. Diabetes Care 1999; 22(Suppl 3):C25–C30.

  7. Kasprzak A, Seidel J, Spachacz R, Biczysko W, Makowska A, Kaczmarek E, et al. Intracellular expression of pro-inflammatory cytokines (IL-1, TNF-α, and IL-6) in chronic hepatitis C. Rocz Akad Med Bialymst 2004; 49: 207–209.

    CAS  PubMed  Google Scholar 

  8. Fernandez-Real JM, Vayreda M, Richart C, Gutierrez C, Broch M, Vendrell J, et al. Circulating interleukin 6 levels, blood pressure, and insulin sensitivity in apparently healthy men and women. J Clin Endocrinol Metab 2001; 86:1154–1159.

    Article  CAS  Google Scholar 

  9. Vozarova B, Weyer C, Hanson K, Tataranni P, Bogardus C, Pratley RE. Circulating interleukin-6 in relation to adiposity, insulin action, and insulin secretion. Obes Res 2001; 9:414–417.

    Article  CAS  Google Scholar 

  10. Lecube A, Hernández C, Genescà J, Simó R. Proinflammatory cytokines, insulin resistance, and insulin secretion in chronic hepatitis C patients: a case–control study. Diabetes Care 2006; 29:1096–1101.

    Article  CAS  Google Scholar 

  11. Aytug S, Reich D, Sapiro LE, Bernstein D, Begum N. Impaired IRS-1/PI3-kinase signaling in patients with HCV: a mechanism for increased prevalence of type 2 diabetes. Hepatology 2003; 38:1384–1392.

    Article  CAS  Google Scholar 

  12. Festa A, D’Agostino R Jr, Howard G, Mykkänen L, Russell P, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000; 102:42–47.

    Article  CAS  Google Scholar 

  13. Knobler H, Schattner A. TNF-{alpha}, chronic hepatitis C and diabetes: a novel triad. QJM 2005; 98:1–6.

    Article  CAS  Google Scholar 

  14. Delgado-Borrego A, Casson D, Schoenfeld D, Somsouk M, Terella A, Jordan SH, et al. Hepatitis C virus is independently associated with increased insulin resistance after liver transplantation. Transplantation 2004; 77:703–710.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mohamed Sayed Hassan MD.

Additional information

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hassan, M.S., Mourad, Y.H. & Elghobary, M.A. Diabetogenic effect of hepatitis C virus and insulin resistance among chronic hepatitis C patients. Egypt J Intern Med 28, 149–154 (2016). https://doi.org/10.4103/1110-7782.203294

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-7782.203294

Keywords