Relationship between hepatitis C virus infection and type 2 diabetes mellitus: meta-analysis.
The aim of this study was to evaluate the relationship between type 2 diabetes mellitus (T2DM) and hepatitis C virus (HCV) infection and to. The chronic form of the hepatitis C virus (HCV) has been shown to be a risk factor for the development of both type 1 and type 2 diabetes. World J Gastroenterol. Apr 14;18(14) doi: /omarcafini.info Relationship between hepatitis C virus infection and type 2 diabetes.
Sample Collection Senior laboratory technologist drew 5 mL venous blood sample using a sterilized disposable syringe, and then the sample was used for the detection of hepatitis C virus by enzyme-linked immunosorbent assay ELISA and HCV genotyping determined by using polymerase chain reaction PCR. Diagnosis of type 2 diabetes mellitus was done according to the American Diabetes Association guidelines [ 18 ]. Other laboratory investigations include complete blood picture, serum cholesterol, serum albumin, total bilirubin, prothrombin time, and serum creatinine levels.
Liver cirrhosis was confirmed if the patient had previous recent reliable reports available or by using radiological investigations and liver biopsy where needed.
Categorical variables were presented as frequency and percentage, and chi-square test was used for nominal categorical variables comparison.
The prevalence of type 2 diabetes mellitus among seropositive patients was calculated and presented as percentage. Multiple logistic regression model was introduced with the dependent variables such as age, gender, weight, BMI, family history of diabetes, and HCV genotype.
Initially, in order to include important variables, factors having significance in univariate analysis were included in the multivariate analysis. The final model was selected using a forward method and.
Male and female proportions were almost equal in our study sample, The majority of the study populations were married Overall prevalence of type 2 diabetes mellitus among HCV seropositive patients was Demographic and clinical characteristics of study participants. Other significant factors in HCV seropositive cirrhotics were male proportion, area of residence, marital status, and type 2 diabetes mellitus Table 1.
Table 2 shows comparison of means between type 2 diabetics and nondiabetic seropositive patients. In univariate analysis, mean age difference 4. Unpaired t-test for the mean differences between diabetic and nondiabetic HCV seropositive patients.
Risk factor distribution between diabetic and non diabetic HCV seropositive subjects.
- Relationship between hepatitis C virus infection and type 2 diabetes mellitus: meta-analysis.
- Journal of Diabetes Research
- Hepatitis C Virus Infection: A Risk Factor for Type 2 Diabetes?
Discussion We observed the prevalence of type 2 diabetes as When we compared the prevalence of type 2 diabetes in HCV-infected population and noninfected population, a twice higher rate of type 2 diabetes was observed in our study as compared to noninfected population [ 19 ]. On the other hand, recent data also suggest three times higher prevalence of type 2 diabetes in HCV seropositive patients [ 21 ].
In this way, data from the previous literature and from our study show a strong association between HCV and type 2 diabetes.
Several reasons can explain the association of type 2 diabetes with HCV. One of the explanations is that the pathophysiology of HCV-associated type 2 diabetes mellitus consists of a defect in insulin secretion, increased hepatic tumor necrosis factor alpha, excessive hepatic glucose production, and insulin resistance, because the core-encoding region of HCV is sufficient to induce insulin resistance by the previously defined mechanism via either direct or indirect way [ 22 ].
Diabetes and Hepatitis C: A Two-Way Association
Secondly, a major contribution of already present risk factors of diabetes such as positive family history and advancing age also plays an important role among HCV infected persons [ 2324 ]. The finding also agrees with another study conducted earlier on Mexican population [ 25 ]. It was observed in our study that positive cases of type 2 diabetes with respect to gender, education level, and marital status had insignificant relation. A study conducted by Elhawary et al. Longer duration of hepatitis C infection has also been noted to increase the risk for diabetes.
Hepatitis C is more common among men than women 51and male gender is also associated with more hepatitis C disease progression to fibrosis and cirrhosis.
It is difficult, however, to precisely tease out the relative contribution of gender itself from confounders like fibrosis and hepatosteatosis, which are themselves markers of more severe liver disease and are associated with higher BMI, larger waist circumference, and a higher HOMA index Family history Family history of diabetes has been demonstrated to be a risk factor for the development of T2D in HCV patients as in the general population This risk is comparable to the two to sixfold increased risk for T2D in the general non-HCV population who have a positive family history for diabetes Across various ethnic groups Pima Indians and populations in the US, Norway, South Africa, and the UKthe risk of developing diabetes is consistently increased among individuals with a positive family history and is up to 4.
Despite these numbers, genotype 1 is relatively less associated with diabetes in the HCV population.
Diabetes and Hepatitis C: A Two-Way Association
Non-genotype 3 HCV particularly genotypes 1, 2, and 4 has been more closely associated with the development of T2D among the hepatitis C population, and interestingly, genotype 2a in particular has been preferentially associated with extrahepatic manifestations of HCV.
Fewer cases of IR were consistently demonstrated among HCV genotype 3 patients, even after adjusting for confounders like BMI and stage of fibrosis 52 However, this has not been consistently demonstrated in all studies These discrepancies may be due to the differences in the number of patients with available genotype data.
Cirrhosis Chronic HCV infection in the absence of cirrhosis or antiviral therapy is associated with T2D 73140 This indicates that it is not the stage of liver disease alone that influences the development of T2D. The presence of fibrosis and cirrhosis, however, in some studies has been shown to be an independent risk factor that contributes to the progression to T2D 313340 Various studies have shown that the rate of T2D is higher among HCV cirrhotics than in other forms of cirrhosis, including cirrhosis caused by HBV, alcohol, or cholestatic disease 5 This suggests a direct diabetogenic effect of the HCV beyond the damage to the liver.
Furthermore, the rates of DM are even more increased on the background of higher grades of hepatic fibrosis, steatosis, or cirrhosis 31334042 Conversely, DM itself has recently been demonstrated to be hasten the progression of fibrosis and cirrhosis underscoring the bidirectionality of the association between chronic HCV infection and IR in chronic HCV infection 57 see Hepatic Fibrosis and Cirrhosis. SVR is defined as undetectable viral load after 24 weeks of treatment.
It is unclear, however, if IR is simply a consequence of poor response to IFN—RBV therapy or if it, on the contrary, mechanistically contributes to treatment resistance. Conversely, there is very strong evidence that hepatic disease progression and response to antiviral therapy are worse with concomitant DM 285461 see Virological Response to Antiviral Therapy.
Mechanisms Hepatic fibrosis and cirrhosis are not the only mechanisms leading to glucose intolerance and frank DM in HCV patients 27 It may be assumed that HCV infection could primarily predispose to T2D through the induction of hepatic steatosis.The relation between new DAA and HCC: friend or foe?
Having both diabetes and HCV may cause other complications. One major risk is advanced liver disease, called cirrhosis. Advanced forms of liver disease can cause liver failure, which can be fatal. Liver transplants are commonly needed for cirrhosis. A recent study has shown that people with both cirrhosis and diabetes have an increased risk for gallstones and urinary tract infections.
Managing both conditions Chronic HCV and diabetes affect one another. HCV is a risk factor for developing diabetes. Having diabetes raises the likelihood of increased complications related to chronic HCV infection.