1321 PREDICTORS OF DIRECTLY MEASURED INSULIN RESISTANCE IN AT-RISK LATINOS WITH AND WITHOUT HEPATITIS C (HCV) INFECTION

Abstract

Background and Aims: HCV is associated with insulin resistance and disproportionately affects Latinos, who in turn have higher rates of diabetes. Factors predictive of insulin resistance in HCVinfected Latinos are not well understood. We aim to compare insulin sensitivity using direct measurements, and assess host and viral factors associated with insulin resistance in Latinos. Methods: 123 non-cirrhotic, non-diabetic Latinos (52 with HCV) were enrolled. All subjects underwent clinical and metabolic evaluation including oral glucose tolerance test and insulin sensitivity by steady-state plasma glucose (SSPG) concentration during the insulin suppression test. Patients in the lowest tertile of SSPG were defined as insulin sensitive (IS) and in the highest tertile as insulin resistant (IR). Results: Overall patient characteristics were: mean age 43±10 years, 64% male, and BMI 27±5 Kg/m. Among HCV-positive patients, 67% were genotype 1, mean log10 HCV viral load was 5.83 IU/mL, and mean ALT 89±73 IU/mL. The mean SSPG in IS (N=40) was of 65±14mg/dL and in IR (N=41) was 239±35mg/dL. On univariable analysis, IS and IR patients were similar with respect to age, family history of diabetes, and tobacco use. However, IR was positively associated with HCV status (OR 1.83, 95%CI 0.7–4.2), female gender (OR 2.38, 95%CI 0.9–5.8), waist circumference (OR 1.21, 95%CI 1.1–1.3), serum LDL (OR 1.02, 95%CI 1.00–1.03), and triglycerides (OR 1.02, 95%CI 1.01–1.04); and negatively associated with HDL (OR 0.93, 95%CI 0.89–0.97), and current alcohol use (OR 0.43, 95%CI 0.97–1.04). On multivariable analysis, controlling for age and family history of diabetes, female gender (OR 13.74, 95%CI 1.99–94.9, p = 0.008), HCV infection (OR 9.13, 95%CI 1.2– 70.1, p = 0.03), waist circumference (OR 1.14, 95%CI 1.04–1.24, p = 0.006), and triglycerides (OR 1.02, 95%CI 1.00–1.04, p = 0.04) were significantly associated with IR. Conclusions: Along with host factors, HCV infection was associated with nine-fold higher odds of directly measured insulin resistance in Latinos. Although male gender is associated with higher diabetic rates, female gender was a strong predictor of insulin resistance among Latinos. The role of other gender-specific factors influencing insulin resistance in this population requires further investigation. Grant support: National Institute of Health, R01-DK074673 (M.K.) and American Diabetes Foundation 1–08-CR-30 (M.K.).