Skip to main content

Study of diabetes mellitus among patients with hepatitis C virus

Abstract

Introduction

Hepatitis C virus (HCV) infection and type 2 diabetes are two common disorders with high impact on health worldwide. There is growing evidence to support the concept that HCV is associated with type 2 diabetes.

Purpose

This work aimed to study the clinical phenotype of type 2 diabetes in HCV patients.

Patients and methods

Our study was conducted upon 100 nonobese, noncirrhotic hepatitis C positive patients who were classified into two groups according to homeostatic model assessment (HOMA) test for insulin resistance (HOMA IR). This study also included 15 nonobese type 2 diabetic patients negative for HCV and hepatitis B virus infection classified as control groups. We excluded alcoholics and drug addicts and patients with conditions that affect blood glucose such as endocrine diseases associated with disordered glucose metabolism and use of drugs. All participants were subjected to full history taking and complete clinical examination including BMI and the following investigations: complete blood count, fasting blood sugar, 2 h postprandial blood sugar, glycosylated hemoglobin, fasting insulin level, cholesterol level, HDL, LDL, triglyceride, serum urea, creatinine, complete urine analysis, liver function tests: total bilirubin, alkaline phosphatase, albumin, prothrombin time, INR, SGOT, SGPT, quantitative PCR for determination of HCV-RNA, surface antigen (HbsAg), abdominal ultrasonography, liver biopsy when needed and possible for HCV patients, and ECG.

Results

In this study, we found that the prevalence of type 2 diabetes in group I is 24%. HCV can independently contribute to IR with viral genotypes 1 or 4. We noticed significant positive correlation between fasting insulin and HOMA IR in hepatitis C +ve patients. IR in HCV-infected patients is high irrespective of the degree of liver injury even before a minimal fibrosis is present. Both IR and diabetes can adversely affect the course of chronic hepatitis C, leading to enhanced steatosis and liver fibrosis, and even increase the risk of hepatocellular carcinoma. A significant correlation between HOMA IR and steatosis, a significant positive correlation between fasting insulin and steatosis and a negative correlation between steatosis and BMI in HCV patients was found. No correlation was found between HOMA IR and the viral load (quantitative HCV RNA).

Conclusion

We can concluded that diabetic HCV patients had intermediate clinical phenotype lower BMI and LDL than control and development of type 2 diabetes mellitus in HCV patients was significantly higher in nontreated patients than treated patients. Antiviral therapy and clearance of HCV improves IR, β-cell function, the blood glucose abnormalities.

References

  1. Albert L, Cristina H, Joan G, et al. Glucose abnormalities with hepatitis C virus infection. Diabetes Care 2006; 29:1140.

  2. Antonelli A, Ferri C, Fallahi P, Pampana A, Ferrari SM, Goglia F, et al. Hepatitis C virus infection:evidence for an association with type 2 diabetes. Diabetes Care 2005; 28:2548–2550.

    Article  Google Scholar 

  3. Marcin S, Zozuliska D, Juszyk J, et al. Hepatitis C Virus infection:evidence for an association with type2 diabetes. Diabetes care 2006; 29:750.

  4. Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastro-enterology 2002; 122:1649–1657.

    Article  Google Scholar 

  5. Papatheodoridis GV, Chrysanthos N, Savvas S, Sevastianos V, Kafiri G, Petraki K, et al. Diabetes mellitus in chronic hepatitis B and C:prevalence and potential association with the extent of liver fibrosis. J. Viral Hepatitis 2006; 13:303–310.

    CAS  Article  Google Scholar 

  6. Miyao M, Shoji M, Shinji A. Decresed plasma adiponectin concentration in wamen with dyslipidemia. J Clin Endoc and Met 2002; 87:2764–2769.

    Article  Google Scholar 

  7. Abraham EG, Blisse E, Gonen E. Glycosylated hemoglobin. Chromatog 1985; 81.

  8. Matthews DR, Hosker JP, Rudenski AS. Homeostasis model assessment:insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28:412–419.

    CAS  Article  Google Scholar 

  9. Matsubara M, Chiba H, Maruoka S, Katayose S. Elevated serum leptin concentrations in women with components of multiple risk factor clustering syndrome. J Atherosc Thromb 2000; 7:231–237.

    CAS  Article  Google Scholar 

  10. García Pagán JC, Calleja JL, Bañares R. Liver diseases [Enfermedades hepáticas]. Gastroenterol Hepatol 2006; 29 (Suppl 3):99–111.

  11. Desmet GL, Soni A, Quinn PG. Clinical features of hepatitis C infected patients with persistently normal alanine transferase levels in United States. Heoatology 2000; 30:1307.

  12. Thuluvath PJ, John PR. Association between hepatitis C, diabetes mellitus and race:a case-control study. Am J Gastroenterol 2003; 98:438–441.

    PubMed  Google Scholar 

  13. Wang CS, Wang ST, Yao WJ, Chang TT, Chou P. Community-based study of hepatitis C virus infection and type 2 diabetes:an association affected by age and hepatitis severity status. Am J Epidemiol 2003; 158:1154–1160.

    Article  Google Scholar 

  14. Moriishi K, Mori Y, Matsuura Y. Processing and pathogenicity of HCV core protein. Uirusu J Virol 2008; 58:183–190.

    CAS  Article  Google Scholar 

  15. Nagao Y, Kawasaki K, Sata M. Insulin resistance and LP in patients with hepatitis C virus infection liver diseases. J Gastroentrol Hepatol 2008; 23:580–585.

    CAS  Article  Google Scholar 

  16. Tsochatzis E, Manolakopoulos S, Papatheodoridis GV, Hadziyannis E, Triantos C, Zisimopoulos K, et al. Serum HCV RNA levels and HCV genotype do not affect insulin resistance in nondiabetic patients with chronic hepatitis C:a multicentre study. Alimen Pharmacol Therap 2009; 30:947–954.

    CAS  Article  Google Scholar 

  17. Sougleri M, Labropoulou Karatza C, Paraskevopoulou P, Fragopanagou H, Alexandrides T. Chronic hepatitis C virus infection without cirrhosis induces insulin resistance in patients with β-thalassaemia major. Eur J Gastroenterol Hepatol 2001; 13:1195–1199.

    CAS  Article  Google Scholar 

  18. Skowroski M, Zozuli D, Juszczyk D, et al. Hepatitis C virus infection:evidence for an association with Type 2 diabetes. Diabetes Care 2006; 29:750.

  19. Björnsson E, Angulo P. Hepatitis C and steatosis. Arch Med Res 2007; 38:621–627.

    Article  Google Scholar 

  20. Jason M. Insulin is associated with chronic hepatitis C virus infection fibrosis progression. Gastoentrol 2003; 2:125.

  21. Moucari R, Asselah T, Cazals Hatem D, Voitot H, Boyer N, Ripault M, et al. Insulin resistance in chronic hepatitis C:association with genotypes 1 and 4, serum HCV RNA level and liver fibrosis. Gastroenterology 2008; 134:416–423.

    CAS  Article  Google Scholar 

  22. Machado MV, Cortez Pinto H. Insulin resistance and steatosis in chronic hepatitis C. Ann Hepatol 2009; 8 (Suppl. 1):S67–S75.

  23. Negro F, Alaei M. Hepatitis C virus and type 2 diabetes. World J Gastro-enterol 2009; 15:1537–1547.

    CAS  Article  Google Scholar 

  24. Merchante N, Macías J, Ramayo E, Vergara S, García García JA, Mira JA, et al. Insulin resistance is not associated with liver fibrosis progression in HIV/ hepatitis C virus-coinfected patients. J Viral Hepatitis 2006; 13:449–456.

    CAS  Article  Google Scholar 

  25. Antonelli A, Ferri C, Fallahi P, Sebastiani M, Nesti C, Barani L, et al. Type 2 diabetes in hepatitis C-related mixed cryoglobulinaemia patients. Rheumatology 2004; 43:238–240.

    CAS  Article  Google Scholar 

  26. 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.

    CAS  Article  Google Scholar 

  27. Castera L, Chouteau P, Hezode C, Zafrani ES, Dhumeaux D, Pawlotsky JM. Hepatitis C virus-induced hepatocellular steatosis. Am J Gastroenterol 2005; 100:711–715.

    Article  Google Scholar 

  28. Kawaguchi T, Ide T, Taniguchi E, Hirano E, Itou M, Sumie S, et al. Clearance of HCV improves insulin resistance, beta-cell function and hepatic expression of insulin receptor substrate 1 and 2. Am J Gastroenterol 2007; 102:570–576.

    Article  Google Scholar 

  29. Simó R, Lecube A, Genescà J, Esteban JI, Hernández C. Sustained vir-ological response correlates with reduction in the incidence of glucose abnormalities in patients with chronic hepatitis C virus infection. Diabetes Care 2006; 29:2462–2466.

    Article  Google Scholar 

  30. Azócar J. Adult onset diabetes mellitus in hepatitis C virus infection. 2003; Available at: mailto:meedo_69@windowslive.com.

  31. Shaw RJ, Lamia KA, Vasquez D, Koo SH, Bardeesy N, DePinho RA, et al. Medicine:the kinase LKB1 mediates glucose homeostasis in liver and therapeutic effects of metformin. Science 2005; 310:1642–1646.

    CAS  Article  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Somayh S. Eissa.

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

Cite this article

Raouf, M.A., Yousry, Z.A., Hindy, O.M. et al. Study of diabetes mellitus among patients with hepatitis C virus. Egypt J Intern Med 24, 17–23 (2012). https://doi.org/10.7123/01.EJIM.0000415588.62804.fc

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.7123/01.EJIM.0000415588.62804.fc

Keywords

  • hepatitis C virus
  • insulin resistance
  • type 2 diabetes mellitus