Diabetes mellitus is a significant risk factor for the development of liver cirrhosis in chronic hepatitis C patients

Abstract

We explored the association between diabetes mellitus (DM) and the risk of hepatitis C virus (HCV)-related liver cirrhosis in Chinese patients with chronic hepatitis C (CHC). To examine the link between DM and liver cirrhosis, we conducted a case-control study of 210 Chinese CHC patients diagnosed with liver cirrhosis, comparing them to an age- and sex-matched control group of 431 CHC patients without liver cirrhosis. We conducted logistic regression analyses adjusting for demographic features and liver cirrhosis risk factors, and found that DM increased the risk of developing liver cirrhosis 2-fold [adjusted odds ratio (AOR), 2.132; 95% confidence interval (CI), 1.344–3.382]. Furthermore, the proportion of liver cirrhosis patients and CHC-only patients with elevated serum triglycerides (>1.8 mmol/L) were 5.2% and 17.4%, respectively, yielding an AOR of 0.264 (95% CI, 0.135–0.517). Multivariate analyses that stratified the risk of developing HCV-related liver cirrhosis in DM patients by gender revealed that the estimated AOR (95% CI) for males was 0.415 (0.178–0.969). In conclusion, DM was associated with an increased risk of developing liver cirrhosis in CHC patients in China. Furthermore, among patients diagnosed with both CHC and DM, females had an increased risk of liver cirrhosis development.

Expert Opinion on Managing Chronic HCV Infection in Patients with Type 2 Diabetes Mellitus

“…Multiple large meta-analyses have shown that chronic HCV infection is associated with an increased risk of T2DM [7,8]. There is strong evidence that T2DM in the context of HCV infection results in increased risk of adverse liver outcomes, such as advanced fibrosis, decompensated cirrhosis and HCC [15][16][17][18][19][20][21][22][23][24].…”

“…4 HCV-associated T2DM has been shown to accelerate the clinical course of chronic HCV infection, significantly increasing the risk of fibrosis and its progression to cirrhosis, decompensation and HCC [15][16][17][18][19][20][21][22][23][24]. Multiple studies have shown a link between T2DM and the development of liver fibrosis.…”

Systematic review: chronic viral hepatitis and metabolic derangement

“…113 HCV infection alters many aspects of the relationship between the liver function and lipoprotein homeostasis, including by impairing the VLDL-releasing pathway, which is one of the causal mechanisms of hepatic lipid accumulation, dyslipidaemia and hypobetalipoproteinaemia. 9 The HCV core and non-structure 5A proteins interact with apolipoprotein (apo)A, 114 apoAII 115 and apoE, 116,117 and so might play roles in liver steatosis, mediated by the derangement of lipid metabolism. The HCV lipo-viral particles contain increased levels of apoC-III that may inhibit the activity of lipoprotein lipase, disturbing the intravascular catabolism of TG-rich lipoproteins.…”

“…In addition, interactions among hepatitis viruses, the host and the environment affect the progression of liver diseases. Considering the host‐related factors, metabolic syndrome (MetS) and associated diseases, such as obesity and insulin resistance/type 2 diabetes mellitus (T2DM), detrimentally affect the course of the disease, especially by accelerating liver fibrosis progression …”

“…Considering the host-related factors, metabolic syndrome (MetS) and associated diseases, such as obesity and insulin resistance/type 2 diabetes mellitus (T2DM), detrimentally affect the course of the disease, especially by accelerating liver fibrosis progression. [7][8][9] MetS is characterised by dysglycaemia, raised blood pressure, elevated triglyceride levels, low high-density lipoprotein cholesterol levels and obesity (particularly central adiposity). 10 It is known that MetS strongly associates with IR and frequently linked to obesity, T2DM and cardiovascular risk.…”