IMPACT OF SUSTAINED VIROLOGICAL RESPONSE OF VIRUS C OUTCOME ON TYPE II DIABETIC PATIENTS INSULIN RESISTANCE AND METABOLIC STATE

Abstract

Background: Diabetes is one of the most prevalent non-communicable diseases throughout the world, affecting 415 million people in 2015. Hepatitis C virus (HCV) infection is widespread, affecting up to 185 million people worldwide. Interestingly, a systematic review has also shown a significant association between the presence of type 2 diabetes mellitus T2D and the risk of HCV infection. Chronic HCV is associated with hepatic and peripheral insulin resistance (IR) . Objective: Investigating the impact of SVR12 following combination of Sofosbuvir and Daclatasvir on IR and metabolic state in type 2 D.M. Patients and Methods: The study was conducted on100 patients. Patients were divided in two groups; group I, that included 30 patients who have both T2D and HCV and did not receive any anti viral drugs, and they served as a control group. Group II, which included 70 patients as a case group who have type 2 DM and HCV and received treatment for 12 weeks according to the Egyptian guidelines using Sofosbuvir and Daclatasvir, and achieved SVR12. All patients were included in the final analysis investigated by fasting and postprandial blood sugar, full lipid profil, HbA1c and microalbuminuria, HOMA- IR , fibroscan and liver enzymes . Serum HCV-RNA was tested at baseline, after 4 weeks, end of treatment, and 12 weeks after the end of treatment. Results showed that cirrhotic patients showed worse metabolic profile as FBS, PPBS, HbA1c, and Homa - IR, serum cholesterol and serum triglycerides compared to non cirrhotic ones at the start of the therapy. Following the achievement of SVR, Group II patients showed a decrease in its mean fasting blood sugar, postprandial blood sugar, HbA1c, albuminuria , Homa - IR score, cholesterol, triglycerides. Group I showed only improvement of cholesterol level. Normalization of SGOT, SGPT, serum bilirubin and serum albumin was recorded only in group II patients, while INR level showed no change from its pretreatment level in both groups. Additionally, fibroscan result improved in group II , while it increased in group I . So, the achievement of SVR in diabetic patients with CHC have a favorable outcome on IR which was more pronounced in non cirrhotic patients. Conclusion: The achievement of SVR in patients with HCV and diabetes mellitus is associated with improvement in Insulin resistance and metabolic markers. This improvement can lead to stopping of anti-diabetic treatment with additional improvement of albuminuria which reflect improvement of vascular complications of IR.