Impact of sustained virologic response on risk of type 2 diabetes among hepatitis C patients in the United States

Abstract

Data regarding the impact of hepatitis C (HCV) therapy on incidence of type 2 diabetes mellitus are limited. We used the data from the longitudinal Chronic Hepatitis Cohort Study-drawn from four large US health systems-to investigate how response to HCV treatment impacts the risk of subsequent diabetes. Among HCV patients without a history of type 2 diabetes mellitus or hepatitis B, we investigated the incidence of type 2 diabetes from 12 weeks post-HCV treatment through December 2015. Cox proportional hazards models were used to test the effect of treatment status (sustained virologic response [SVR] or treatment failure) and baseline risk factors on the development of diabetes, considering any possible risk factor-by-SVR interactions, and death as a competing risk. Among 5127 patients with an average follow-up of 3.7 years, diabetes incidence was significantly lower among patients who achieved SVR (231/3748; 6.2%) than among patients with treatment failure (299/1379; 21.7%; adjusted hazard ratio [aHR] = 0.79; 95% CI: 0.65-0.96). Risk of diabetes was higher among African American and Asian American patients than White patients (aHR = 1.82 and 1.75, respectively; P < .05), and among Hispanic patients than non-Hispanics (aHR = 1.86). Patients with BMI ≥ 30 and 25-30 (demonstrated higher risk of diabetes aHR = 3.62 and 1.72, respectively; P < .05) than those with BMI < 25; patients with cirrhosis at baseline had higher risk than those without cirrhosis (aHR = 1.47). Among a large US cohort of patients treated for HCV, patients who achieved SVR demonstrated a substantially lower risk for the development of type 2 diabetes mellitus than patients with treatment failure.

Letter: HCV complication and type 2 diabetes management—the directional link is not yet defined. Authors’ reply

“…3 Our own recent paper showed thatamong a large US cohort of patients who received antiviral treatment for HCV-patients who achieved SVR demonstrated a substantially lower risk for development of T2D than patients with treatment failure. 3 Another question raised by Mahla is whether HCV treatment improves glucose metabolism in T2D patients. Although there are a number of reports of significant decreases in haemoglobin A1c…”

“…Studies from the interferon era suggested that sustained virological response (SVR) reduces the risk of future insulin resistance and T2D, 3 while other studies found no difference between treated and untreated HCV patients. 3 Our own recent paper showed thatamong a large US cohort of patients who received antiviral treatment for HCV-patients who achieved SVR demonstrated a substantially lower risk for development of T2D than patients with treatment failure. 3 Another question raised by Mahla is whether HCV treatment improves glucose metabolism in T2D patients.…”

“…7% prevalence HCV/HBV dual infection, whereas HCV and HBV mono-infection prevalence, are 5.7% and 9.9% respectively. 3 Age, BMI, gender, education and race-stratified multivariate linear regression analysis model suggests a risk association between T2D prevalence and HBV/HCV co-infection, a foreseen potential burden to national healthcare policies. 3 Is it apparent that DAA treatment of HCV improves glucose metabolism in T2D patients?…”

“…3 Age, BMI, gender, education and race-stratified multivariate linear regression analysis model suggests a risk association between T2D prevalence and HBV/HCV co-infection, a foreseen potential burden to national healthcare policies. 3 Is it apparent that DAA treatment of HCV improves glucose metabolism in T2D patients? A concurrent study finds that prescription of insulin improves DAA treatment outcomes for HCV patients with T2D (N = 122).…”

“…4 It is clear from available research outcomes that HCV infection has a clear association with increased risk of T2D prevalence across various populations. [1][2][3][4] A cross-sectional study from Saudi Arabia (N = 300), investigating the association between the two conditions finds 8% and 2% respective prevalence of HCV among T2D and nondiabetics. 5 Multivariate regression analysis for the prevalence outcomes defines an increased prevalence of HCV infection in T2D patients.…”