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DIABETES IN HCV
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CORRELATION OF CHRONIC HEPATITIS B AND C WITH DIABETES MELLITUS
Ch. Drakoulis, M. Minadaki, L. Karasavidou, M. Panidou, Ch. Liarou, Ch.
Samaras, K. Stagia, D. Katsadoros Hepatology Department, 2nd Pathology
Clinic, General Hospital of Nikea, Piraeus, Greece
Aim: To examine the frequency of Type II diabetes in patients with chronic
hepatitis B (CHB) or C (CHC).
Materials & Methods: 850 patients attending our clinic were examined. 98 were
found with CHB (positive for HbsAg, anti-HBe, anti-HBc by ELISA and HBV-DNA
by PCR) and 117 with CHC (positive for anti-HCV by 3rd generation ELISA).
Patients were classified by gender, age and blood glucose levels.
Results: For the CHB patients, 31 males (57.4%) and 27 females (61.3%) had
blood glucose < 110 mg/dl, 11 males (20.4%) and 7 females (15.9%) had blood
glucose 110-126 mg/dl, and 12 males (22.2%) and 10 females (22.8%) had blood
glucose > 126 mg/dl. For the CHC patients, 48 males (68.6%) and 34 females
(72.4%) had blood glucose < 110 mg/dl, 9 males (12.8%) and 4 females (8.5%)
had blood glucose 110-126 mg/dl, and 13 males (18.6%) and 9 females (12.9%)
had blood glucose > 126 mg/dl.
Conclusions: In CHB patients, abnormal fasting glucose levels were observed
in both males and females with similar frequency (mean 18%), mostly at ages
41-60 years. In CHC patients, abnormal fasting glucose levels were observed
more frequently in males (12.8%) than females (8.5%), again mostly at ages
41-60 years. The overall frequency of Type II diabetes in both CHB and CHC
patients is greater than that of the general population. Our results show a
slightly higher incidence of diabetes mellitus in CHB patients, although it
is not statistically significant.
GLUCOSE INTOLERANCE IN CHRONIC HEPATITIS C AND B: RISK FACTORS AND PREVALENCE
IN GENERAL POPULATION
Emanuel Manesis 1 , Anastasia Mavrogiannaki 1 , Elias Siakavellas 1 , Basil
Karamanos 1, Stephanos Hadziyannis 2 1 Academic Department of Medicine,
Hippokration General Hospital, Athens; 2 Henry Dynan Hospital, Athens, Greece
Diabetes is frequent among patients with chronic hepatitis C (CHC), but its
pathogenesis is lacking.
Methods: We prospectively evaluated 100 consecutive patients with chronic
viral hepatitis (57 CHC, 43 HBeAg-negative chronic hepatitis B [CHBeoooo ])
admitted for liver biopsy and compared them to 100 healthy controls, matched
for age, sex and body mass index. Controls were randomly selected from a
large database of a recent field study of diabetes prevalence performed by us.
Results: Known diabetes was not significantly different among CHC, CHBeoooo
or controls (12.5%, 4.7% and 10% respectively; P = 0.424), but abnormal
glucose tolerance (glucose intolerance or diabetes discovered by OGTT) was
significantly higher in CHC than in controls (40.4% vs 14%, respectively; P <
0.001; OR 4.2, 95% CI 1.9-9.0) and not different between CHBeoooo and
controls (14% vs 14%). By logistic regression analysis, significant
predictors of abnormal OGTT in patients with chronic viral hepatitis were,
HCV infection (RH 5.1, 95% CI 1.4-19.3; P = 0.016), serum ALT (RH 2.3, 95% CI
1.3-5.1; P = 0.007) and IgG levels (RH 12.4, 95% CI 1.8-84.9; P = 0.010).
Conclusions: Prevalence of glucose intolerance and new diabetes discovered by
OGTT is 4.2 times higher in CHC but not different in CHBe patients compared
to general population. Continuous hepatic necroinflammation and chronic
immunological stimulation underlie and possibly are pathogenetically related
to increased prevalence of diabetes in CHC.
HEPATITIS C AND DIABETES MELLITUS: WHAT IS THE CONNECTION?
Antonio Garrido 1 ,F.J.Guerrero 2 ,J.A.Lepe 3 ,S.Palomo 2 , A. Grilo 4
1 Department of Gastrointestinal Medicine, H. Riotinto (Huelva); 2 Department
of Internal Medicine, H. Riotinto (Huelva); 3 Microbiology Unit, H. Riotinto
(Huelva); 4 Department of Internal Medicine, H. Valme, Sevilla, Spain
Objectives: To carry out a prospective study of baseline insulinemia in
non-diabetic cirrhotic patients infected with HCV, comparing their values
with those of a group of non-HCV non-diabetic cirrhotic patients. To research
the factors involved in both groups in the increase of peripheral resistance
to insulin.
Material: A trial including 32 HCV cirrhotic diabetic patients (Group I) and
41 non-diabetic cirrhotic patients of other aetiologies (Group II) was
carried out. Baseline insulinemia as well as insulin resistance factors like
age, anthropometric indices, stage of cirrhosis and iron plasma levels were
compared.
Results: The average baseline insulinemia values in group I was 21.5 mU/ml
(18.6-24.4), vs 14 mU/ml (10-18) in group II (p < 0.001), and the percentage
of hyperinsulinemia was 87.5% (72.5- 95.9) vs 56% (40.8-70.6), respectively
(p < 0.01). No differences were observed in either group when comparing age,
weight, height, body mass index and Child-Pugh staging score. Whereas serum
ferritin levels in Group I patients were higher than those in Group II [123.3
(12.4-289.3) vs 65.5 (2.4-306) ng/ml, p < 0.05]. Multivariate logistic
regression study demonstrated that insulinemia values (OR = 1.21; CI 95%
1.09-1.34, p < 0.001) and ferritin levels (OR = 1.21; CI 95% 1.02-1.052.69, p
< 0.04) were independent factors associated to HCV.
Conclusions: HCV-positive non-diabetic cirrhotic patients have higher
baseline insulinemia levels, as well as a greater prevalence of
hyperinsulinemia than cirrhotics due to other aetiologies. This could be
explained by an increase of peripheral insulin resistance, mediated by the
increase of iron deposits in these patients, and may be responsible for the
increased risk of developing diabetes mellitus.
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