Inadequate serum hepcidin levels in chronic hepatitis C infection-induced type 2 diabetes mellitus

Abstract

Background Hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. In addition to established liver injury, type 2 diabetes mellitus (T2DM) is one of the most important extrahepatic metabolic disorders that are attributed to HCV infection. Aim The aim of this study is to investigate the impact of HCV infection in the development of T2DM through the assessment of serum hepcidin levels. Patients and methods The study included 60 Egyptian patients with chronic HCV infection who were divided according to the presence and absence of diabetes into two groups: 30 HCV-positive patients who developed diabetes mellitus during the course of HCV infection (HCV-T2DM patients) and 30 HCV-positive patients without T2DM (HCV patients) and 20 healthy individuals as a control group (age and sex matched). They were subjected to a full assessment of medical history, clinical examination, abdominal ultrasound, and laboratory investigations including complete blood count, liver function tests, fasting blood sugar (FBS), glycosylated hemoglobin, fasting insulin, serum hepcidin, serum ferritin, serum iron, and transferrin saturation. Serum hepcidin, ferritin, and insulin were measured using an enzyme-linked immunosorbent assay. Results We found that serum hepcidin was statistically significantly lower in HCV patients than in controls (P<0.0001). Also, serum hepcidin in HCV-T2DM patients was statistically significantly lower than that in HCV-positive patients (P<0.05). Serum ferritin was statistically significantly higher in HCV-positive patients than in controls (P<0.0001). Also, serum ferritin was statistically significantly higher in HCV-T2DM patients than in HCV patients (P<0.0001). Serum iron and serum transferrin saturation were statistically significantly higher in HCV-T2DM patients than HCV-positive patients (P<0.0001 and <0.0001, respectively). There was a statistically significant increase in fasting blood glucose, glycosylated hemoglobin, and fasting insulin in HCV-T2DM patients compared with HCV nondiabetic patients (P<0.0001 for all). Also, we found that the serum albumin was statistically significantly lower in HCV-T2DM patients compared with HCV-positive patients (P<0.0001). Conclusion HCV infection is associated with a decreased level of hepcidin in relation to body iron store, which plays a crucial role in the development of T2DM in chronic HCV infection patients.