Risk factors for diabetes mellitus and early insulin resistance in chronic hepatitis C

doi:10.1016/S0168-8278(01)00143-X

Journal of Hepatology

Volume 35, Issue 2, August 2001, Pages 279-283

https://doi.org/10.1016/S0168-8278(01)00143-X Get rights and content

Abstract

Background/Aims: Our aims were to investigate the host and viral specific factors associated with diabetes mellitus (DM) and insulin resistance in chronic hepatitis C patients.

Methods: One hundred and three hepatitis C virus (HCV)-infected were studied to assess the effects of HCV genotype, hepatic iron content, steatosis, hepatic fibrosis, body mass index (BMI) and family history of DM on the occurrence of DM. Insulin resistance (HOMA IR) was studied in 81 non-diabetic patients to determine the mechanism associated with insulin resistance in this subgroup.

Results: Sixteen of the 123 were diabetic (13.0%). The variables predictive of DM were METAVIR fibrosis score 4 (OR, 13.16; P=0.012), family history of diabetes (OR, 16.2; P=0.0023), BMI (OR, 1.37; P=0.017) and age (OR, 1.09; P=0.002). In non-diabetic HCV-infected patients, HOMA-IR of METAVIR fibrosis score 0 and 1 patients were significantly different than score 2 and score 3/4 patients.

Conclusions: Our findings indicate that older age, obesity, severe liver fibrosis and family history of diabetes help identify those HCV patients who might have potential risk factors for development of DM. We observed that insulin resistance in non-diabetic HCV-infected patients was related to grading of liver fibrosis, and occurs already at an early stage in the course of HCV infection.

Introduction

A link between chronic hepatitis C virus infection (HCV) and type 2 diabetes mellitus has recently been suggested [1], [2], [3], [4], [5], [6], [7], [8], [9]. Several studies have reported a higher prevalence of hepatitis C (HCV) in diabetic patients (11–28%), compared with control groups [1], [2]. Others have found a higher prevalence of diabetes mellitus in-patients with chronic HCV infection [3], [4], [7], [9]. The prevalence of diabetes in HCV infection is higher than in other chronic liver diseases, including hepatitis B [3], [7]. This higher prevalence of diabetes mellitus (DM) in HCV patients is not related exclusively to cirrhosis. Non-cirrhotic patients with chronic HCV have an increased prevalence of type 2 diabetes compared to non-cirrhotic patients with chronic hepatitis B virus [8].

The pathogenesis of diabetes in patients with HCV is not well understood but an increase in fat or iron deposition in the liver is common in patients with HCV [10], [11]. Insulin resistance related to excess liver fat, or excess iron deposition may have a role and has not been investigated. It has been suggested that liver fat may contribute to insulin resistance in HCV infected patient [12]. Similarly, the relationship between iron and the development of diabetes mellitus is well known [13]. An increased of iron store, even in the range not considered to be associated with haemochromatosis, contributes to the development of NIDDM [13].

The purpose of this study was to investigate the host and viral specific factors associated with the development of diabetes mellitus and insulin resistance in patients with chronic hepatitis C. The study comprised two components: (i) a study of 123 consecutive patients with untreated chronic HCV to assess the effects of HCV genotype, viral load, hepatic iron content, steatosis, hepatic fibrosis, body mass index (BMI) and family history of diabetes mellitus on the occurrence of diabetes mellitus; (ii) an investigation of insulin resistance (HOMA IR) and β-cell function (HOMA β-cell) evaluated by the HOMA model assessment in non-diabetic patients to determine the factors associated with insulin resistance in this group.

Section snippets

Patients

One-hundred and twenty-three untreated chronic hepatitis C patients were studied from January 1996 to December1999. All of them were hospitalised for liver biopsy. The demographic data collected at the time of liver biopsy included age, sex, alcohol use and family history of diabetes. BMI was calculated as body weight in kilograms divided by the square of height in meters (kg/m²). Information regarding average alcohol intake was assessed by interview. The alcohol intake was recorded in grams

Patient demographics and laboratory evaluation.

The main clinical and laboratory data are summarized in Table 1. The mean age was 44.2±12 years (range, 20–77 years); 79 (64.2%) patients were male. The mean BMI was 23.5±3.36 (range, 17.3–36.5 kg/m²), 16 (13.0%) patients had diabetes mellitus. Diabetes was managed mostly by diet alone (n=8) or oral hypoglycemic agents (n=7) and in only one patient by insulin. The diagnosis of diabetes mellitus was new in four patients. The mean of duration of overt diabetes mellitus was 9.6±6.5 years in the

Discussion

In our series, diabetes mellitus was present in 13.0% of chronic hepatitis C patients. Our findings indicate that older age, obesity, severe liver fibrosis and family history of diabetes help to identify the HCV patients who might have a potential risk for developing of diabetes mellitus.

The pathogenesis of diabetes in patients with hepatitis C is not well understood. It has been suggested that the physiopathology of diabetes mellitus in HCV patients may result from steatosis [12]. Liver fat

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Risk factors for diabetes mellitus and early insulin resistance in chronic hepatitis C

Abstract

Introduction

Section snippets

Patients

Patient demographics and laboratory evaluation.

Discussion

J Hepatol

Mayo Clin Proc

J Hepatol

Hum Pathol

J Hepatol

Gastroenterology

Gastroenterology

J Hepatol

Gastroenterology

High prevalence of hepatitis C virus infection in diabetic patients

Diabetes Care

Increased prevalence of hepatitis C virus antibodies in patients with diabetes mellitus

J Intern Med

Association of diabetes mellitus and chronic hepatitis C virus infection

Hepatology