Rapid decline of fasting glucose in HCV diabetic patients treated with direct-acting antiviral agents

Abstract

Association between hepatitis C virus (HCV) infection and diabetes has been widely postulated. Little is known about the effect of direct-acting antiviral agents (DAAs) on glycaemic control. The aim of our study was to evaluate the glycaemic control modifications in a case series of HCV-positive diabetic patients receiving DAAs. We retrospectively evaluated 149 HCV-positive patients in two different institutions affiliated with Sapienza University: Policlinico Umberto I of Rome and Ospedale Santa Maria Goretti of Latina. We were able to identify 29 patients with type 2 diabetes mellitus (19% of total population) who were receiving different interferon-free regimens. During-treatment fasting glucose (FG) values were available for 21 patients, and analysis revealed a statistically significant reduction (p 0.007); reduction mean value was -52.86 mg/dL. A glycated haemoglobin (A1C) value during treatment (at weeks 4, 8 and/or 12) was available for ten patients, and the analysis revealed a statistically significant reduction (p 0.021) with a reduction mean value of -1.95%. Six patients (23%) needed to reduce hypoglycaemic drugs, eight of ten patients showed reduction of A1C and 14 (67%) of 21 patients showed reduced FG during treatment. FG and A1C reductions values were independent from which DAA was present in the regimen, HCV genotype, body mass index and HIV status. In order to avoid hypoglycaemic events, diabetic patients receiving DAAs should be closely monitored for reduction of hypoglycaemic drugs. Furthermore, in our opinion, diabetes could be considered as an element to prioritize treatment in those patients with no apparent liver disease.

The Effect of Hepatitis C Virus Eradication with New Direct Acting Antivirals on Glucose Homeostasis in Non-Diabetic Egyptian Patients

“…This is in agreement with several studies [12,[15][16][17]. Abdel Alem et al, found a reduction in both FBS and HbA1c after HCV eradication [18].…”

Metabolic Syndrome and Genotype 1 Virus C Compensated Liver Cirrhosis in the Era of Directly Acting Antiviral Therapy

“…5 after SVR is attained using DAA therapy. Similar results are recently published using other treatment regimens (9,31). The reversibility of hypocholesterolemia, hypotriglyceridemia, and hepatic steatosis is demonstrated after the attainment of SVR in therapy regimens based on interferon (32)(33)(34).…”

Markedly Improved Glycemic Control in Poorly Controlled Type 2 Diabetes following Direct Acting Antiviral Treatment of Genotype 1 Hepatitis C

“…Recent data suggest that HCV infection directly impairs glucose metabolism and contributes to insulin resistance [2]. Treatment of genotype 1 HCV infection with interferon based regimens or direct acting antiviral agents (DAAs) has correlated with improved insulin sensitivity and glycemic control in both insulin dependent and noninsulin dependent T2DM [3–7]. We report a case of mixed genotype 1a/1b HCV infection with compensated cirrhosis treated with DAAs resulting in significant improvement of poorly controlled T2DM despite increasing body mass index (BMI).…”