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High prevalence of diabetes mellitus in patients with chronic hepatitis C. A case-control study
S Grimbert1, P Valensi, C Lévy-Marchal
1Service d'Hépato-Gastroentérologie, Hôpital Jean-Verdier, Bondy.
Insights
Hepatitis C virus infection is linked to a higher prevalence of diabetes mellitus, particularly non-insulin-dependent diabetes. This suggests a potential role for hepatitis C virus in the development of diabetes.
Area of Science:
- Hepatology
- Endocrinology
- Virology
Background:
- Extrahepatic manifestations are recognized complications of hepatitis C virus (HCV) infection.
- The association between HCV and diabetes mellitus requires further investigation.
Purpose of the Study:
- To evaluate the relationship between chronic hepatitis C and the prevalence of diabetes mellitus.
- To compare diabetes prevalence in HCV patients with that in patients with other liver diseases.
Main Methods:
- A case-control study involving 152 patients with chronic hepatitis C and 152 matched controls with hepatitis B or alcohol-induced liver disease.
- Exclusion criteria included severe liver decompensation.
- Diabetes was defined by elevated fasting serum glucose or prior diagnosis.
Main Results:
- Diabetes mellitus was significantly more prevalent in patients with chronic hepatitis C (24%) compared to controls (9%, P < 0.002).
- The majority of diabetic patients (81%) had non-insulin-dependent diabetes, and 88% had cirrhosis.
- Diabetic patients with chronic hepatitis C showed lower plasma C-peptide and insulin levels compared to diabetic controls, and fewer had a family history of diabetes or obesity.
Conclusions:
- Diabetes mellitus is more common in individuals with chronic hepatitis C than in those with other liver diseases.
- The findings suggest that hepatitis C virus infection may play a role in the pathogenesis of diabetes, often occurring without typical predisposing factors.
Objectives And Methods:
Extrahepatic manifestations have been reported in hepatitis C virus infection. To assess the relationship between diabetes mellitus and hepatitis C virus, we studied 152 patients with chronic hepatitis C and 152 controls hospitalized during the same period with hepatitis B virus (n = 51) or alcohol-induced (n = 101) liver diseases matched for age, sex, and the presence of cirrhosis (prevalence: 58%). Patients with jaundice, ascites, encephalopathy, prothrombin activity < 65%, or serum albumin < 35 g/L were excluded.
Results:
Diabetes, defined by fasting serum glycemia > 1.4 g/L on at least two separate occasions or previously treated overt diabetes, was present in 38 patients with chronic hepatitis C (24%) and in 13 patients in the control group (9%, P < 0.002). In the 51 diabetic patients, irrespective of serum anti-hepatitis C virus status, 41 (81%) had non insulin dependent diabetes and 45 (88%) had cirrhosis. Family history of diabetes or obesity was observed in 2 (5%) of the diabetic patients with chronic hepatitis C and in 6 (46%) of the diabetic controls (P = 0.002). Plasma C-peptide (855 +/- 448 pmol/L versus 1,152 +/- 491 pmol/L, NS) and insulin levels (83 +/- 40 pmol/L versus 184 +/- 86 pmol/L, NS), assayed in 17 diabetic patients with chronic hepatitis C and in 9 diabetic controls, were lower in the former. The prevalence of HLA B8, DR3 or DR4 antigens, which was searched for in 77 patients with chronic hepatitis C, was not different in diabetic and non diabetic patients, and, was similar to the reference population. Serum islet-cell antibodies were found in 5 patients with chronic hepatitis C (3 with diabetes) and in 2 controls.
Conclusion:
Diabetes mellitus is more prevalent in patients with chronic hepatitis C than in patients with other liver diseases, and usually occurs in the absence of predisposing factors. These results suggest a role of hepatitis C virus infection in the pathogenesis of diabetes.