Onset of type 1 diabetes mellitus during peginterferon ??-2b plus ribavirin treatment for chronic hepatitis C

Abstract

A 61-year-old man was observed to develop type 1 diabetes mellitus following a 3-month treatment with recombinant alpha-2b peginterferon combined with ribavirin for chronic hepatitis C. Serum samples, collected before the start of therapy and 2 months after the diagnosis of diabetes mellitus, revealed islet-cell antibodies at a titer of 20 and 40 JDF-U, respectively, and glutamic acid decarboxylase autoantibodies at a value of 76.5 and 196 IU/ml, respectively. Antibodies to second islet autoantigen were persistently negative. HLA class II typing revealed the presence of DRB1*04/DRB1*14, DQA1*0303-0104 and DQB1*04-0503 alleles. Eight months after the onset of type 1 diabetes mellitus, the patient is still receiving 30 IU insulin daily; the liver function tests are normal and serum hepatitis C virus RNA is negative. These data confirm that, in patients with potential diabetes mellitus, the disease may become manifest as a side-effect during therapy with peginterferon-alpha plus ribavirin. The patient as a candidate for interferon treatment should therefore be investigated, in addition to thyroid autoimmunity, also for pancreatic autoantibodies before starting therapy.

Trajectories of anti-islet autoantibodies before development of type 1 diabetes in interferon-treated hepatitis C patients. Case reports and a literature review

“…He had no family history of diabe-body negative even after the onset of type 1 diabetes, although data for some autoantibodies such as ZnT8Ab were not available. These results suggest that GADAb may be a good predictive and diagnostic marker for IFN-induced type 1 diabetes, as has been reported in sporadic cases [2][3][4][5][6][7][8][9][10][11][12]. This needs to be verified in the future study using a large number of subjects.…”

Simultaneous development of diabetic ketoacidosis and Hashitoxicosis in a patient treated with pegylated interferon-alpha for chronic hepatitis C

“…Pancreatic autoimmunity markers were not assessed. In the case presented by Cozzolongoa et al [22] , IDDM developed following a 3-mo treatment with pegylated IFN-α-2b and ribavirin for CHC. An increase in the titers of isletcell and glutamic acid decarboxylase antibodies before the start of therapy and 2 mo after the diagnosis of diabetes mellitus was documented.…”

“…To date, the development of IDDM during pegylated IFN-α and ribavirin therapy for CHC was documented in only two cases in the English literature [21,22] . In the case reported by Jabr et al [21] , pegylated IFN-α and ribavirin were administered in a patient with CHC and human immunodeficiency virus infection.…”

Diabetic Ketoacidosis

“…Until 2005, 35 cases of IFN-α related T1DM had been reported in the medical literature [64,[66][67][68][69]. DKA was reported in a few classical IFN-α related cases [70][71][72][73], in three pegylated IFN-α related cases [65,74,75]. The development of DKA and the permanent insulin dependency may be related with a rapidly developing T helper-1-mediated pathogenic mechanism [72].…”