| Does HCV Cause Diabetes? |
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Thursday, 02 April 2009 10:17
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It has been proven that hepatitis C causes insulin resistance, a pre-cursor to type II diabetes or diabetes mellitus (DM). However, it has not been proven that HCV causes diabetes. One way to prove that HCV causes diabetes is by studying what happens after successful treatment of HCV – the hepatitis C virus is eliminated – and observing whether or not the incidence of diabetes is lower than in the patients who did not eliminate the hepatitis C virus. This is exactly what researchers in Japan wanted to answer by conducting one of the largest clinical trials to date on diabetes and HCV. Researchers Arase and colleagues conducted a retrospective1 (looking back over time) study of 5,890 patients who were diagnosed with chronic hepatitis C in the Department of Hepatology, Toranomon Hospital, Tokyo, Japan. Of the original 5,890 patients evaluated for diabetes, 2,842 patients did not have diabetes pre-treatment (but could have had pre-diabetes) before and for 3 months after completion of HCV treatment. Two thousand-four hundred and seventeen patients received standard interferon monotherapy and 425 received standard interferon plus ribavirin therapy. The primary aim of the study was to compare the incidence of diabetes in the patients who achieved an SVR to that in those who did not achieve an SVR. The researchers also looked for other factors associated with the onset of diabetes using the 2003 criteria of the American Diabetes Association. The average period that the patients were observed was 6.4 years. The sustained virological response rates (SVR-HCV RNA or viral load undetectable 24 weeks post-treatment) in the interferon monotherapy group was 36.7%, and 68% in the group that was treated with interferon plus ribavirin. One hundred and forty-three patients (102 men and 41 women) developed diabetes during the observation period (mean period = 6.4 years). Using a statistical method (Kaplan-Meier) to determine the cumulative development rate of diabetes, the incidence of diabetes was found to be 3.6% at 5 years, 8.0% at 10 years and 17.0% at 15 years. When the results were compared between the two groups, the group that did not achieve an SVR had a higher onset of diabetes compared to the group that achieved an SVR. Furthermore, it was found that when an SVR was achieved that there was a two-thirds reduction in the onset of diabetes. The factors that were found to be associated with the onset of diabetes after therapy was completed were advanced fibrosis, non-SVR, pre-diabetes, and an age greater than or equal to 50 years old. These results are important because if diabetes can be prevented with successful treatment of hepatitis C the future disease burden of diabetes and hepatitis C can be significantly lowered. 1 The original study was a prospective clinical study using the older diagnostic criteria of diabetes, but during the trial period the American Diabetes Association changed the diagnostic criteria. Reference http://www.hcvadvocate.org/news/newsLetter/2009/advocate0409.html#2 Add this page to your favourite Social Bookmarking websites;         
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