Glucose tolerance in viral hepatitis. A study of twenty patients during the acute phase and after recovery.

Abstract

Twenty patients with viral hepatitis were investigated during the acute phase and after recovery in order to study their glucose tolerance. During hepatitis, three tests were performed: oral and intravenous glucose tolerance tests and tolbutamide test, with measurements of glucose, insulin, free fatty acids, trigiycerides, growth hormone, and cortisol. After recovery, a control oral glucose tolerance test was performed. All these results were compared with those of healthy controls. During the acute phase, both oral and intravenous glucose tolerance tests showed two groups of patients: nine with normal glucose tolerance but significant hyperinsulinism, and 11 with glucose intolerance but a delayed and not increased insulin response. Tolbutamide test was always normal, without any difference between these two groups. Free fatty acids (FFA) were increased only in the glucose-intolerant group; there was a significant negative correlation between basal FFA and the K values. Trigiycerides were increased in the two groups, but were higher in the normal glucose-tolerant one. Growth hormone and cortisol were increased only when the K value was very low. All these parameters returned to normal in all the patients after their recovery. Clinical features, hepatic tests, and HLA typing were similar in the two groups, with no significant differences. A comparative group of patients with mild and nonhepatic infections did not show any abnormalities. This study suggests there is a transitory insulin-resistant state during viral hepatitis, which can be due to an increase in FFA concentrations. Glucose intolerance occurs in half of the cases, possibly as a consequence of an additional β-cell impairment.