INFO: Diabetes and Hepatitis C

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Diabetes and Hepatitis C Prof. Dr. med. J. Reichen

It is now clear that hepatitis C conveys a risk to develop diabetes mellitus, in particular type 2: in a cross sectional national survey on 9841 adults, the prevalence of diabetes and hepatitis C were 8.4 and 2.1 %, respectively (1); persons with age over 40 and hepatitis C had a 3.8 increased risk to have diabetes in this study. Mason and colleagues found 4. 1 of patients with diabetes to have HCV as compared to 1. 6 % of controls; moreover genotype 2A was more frequent in diabetics than in the hepatitis C controls (2). For the different odds ratios (OR), see table 1. The prevalence of diabetes in patients with cirrhosis increases with the Child-Pugh score (3). The major mechanism appears to be insulin resistance which is related to the fibrosis score (4, 19). However, this can not be the sole mechanism since the prevalence is also increased compared to other liver diseases (see table). A recent study clearly demonstrated, that hepatitis C is a precipitating factor for diabetes but only in patients with risk factors to develop such (20). One study suggests that cross-reactivity of LKM autoantibodies with islets could lead to endocrine disorders (5). Among patients with hepatitis C, fibrosis score (cirrhosis: OR 13.2) and family history of diabetes (OR 16.2) were strongly predictive of diabetes (19). This is particularly a problem after liver transplantation: at 5 years 41 % of patients transplanted for hepatitis C had diabetes, 89 % requiring insulin (6). Also in HIV-HCV coinfected patients, the presence of insulin resistance is increased compared to HIV under HAART (7).

Table 1 Prevalence of diabetes mellitus in patients with hepatitis C

Patient group

Hepatitis C

Type of Control

Prevalence

OR

Ref

Chronic hepatitis

21 %

Hepatitis B

12 %

(2)

Noncirrhotics

33 %

No liver disease Hepatitis B

5.6 % 12 %

(8)

Cirrhosis

23.6 %

Hepatitis B

9.4 %

2.78

(3)

Cirrhosis pre OLT

50 %

Other CLD

9 %

10.0

(9)

Cirrhosis pre OLT

29 %

Hepatitis B Cholestasis

6 % 4 %

(6)

Pre OLT

25 %

Cholestasis Alcohol

1.3 % 19%

(10)

The prevalence of autoantibodies associated with diabetes mellitus type 1 is not higher in patients with hepatitis C (11;12) and does not increase after interferon treatment (12). Different results were reported by Wesche et al.: GADA and IA2 appeared in 5 and 1/62 patients treated with interferon, respectively; none developped overt diabetes (13). There are several case reports of onset of type 1 diabetes during interferon treatment (14;15). In an Italian series 1/70 patients treated with interferon had an increase in ICA titers and developed diabetes mellitus type 1 (11); these authors did not implicate interferon in development of diabetes. Another study found an increase in insulin autoantibodies from 3.3 % before to 13.3 % after treatment with no patient developing diabetes (16). In a national survey, 10/11'241 developed diabetes during or after interferon treatment (17). This figure was higher in Japan, were 5/677 patients treated with (high dose) interferon developped diabetes (18). Reference List

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