Abstract
Purpose: HepatitisC (HCV) is believed to cause insulin resistance and non-insulin dependent diabetes (NIDDM) through expression of TNF-α. This association is observed regardless of the stage of liver disease. It is also known that advanced cirrhosis causes impaired glucose tolerance regardless of etiology. Insulin resistance has been implicated in the progression of liver fibrosis and decreased sustained virologic response to interferon therapy. Insulin resistance is also known to be a risk factor for metabolic syndrome. We examined the relationship between insulin resistance in early HCV patients and the appearance of risk factors for metabolic syndrome. Methods: A prospective sample of 42 HCV patients [mean MELD score of 7.5 ± 4.2(sd)] was examined at our University teaching hospital. Patients had no history of NIDDM. Data were collected on patient's age, gender, waist circumference, BP, BMI, race, clinical labs including fasting HDL, triglycerides, glucose and insulin, HCV risk factors and drug treatment for HCV. Data were analyzed by normal BMI vs. elevated BMI, by Homeostasis Model Assessment for Insulin Resistance (HOMA-IR) and by fasting insulin using student t-tests, chi-square analysis, multiple linear and logistic regression analysis. Results: Patient age ranged from 30–87 years [mean = 5 ± 13(sd) yrs]; 71% were male. Insulin resistance was found in 76%(33/42) of patients (HOMA-IR used). Eleven patients (26%) had impaired glucose tolerance and 21 (50%) had NIDDM. Patients with insulin resistance had a 61-fold increased risk of low HDL (P = .025) and the effect was greatest in males (116-fold increase likelihood). No association between insulin resistance and other parameters of metabolic syndrome was observed. These findings were independent of patient's BMI. Conclusions: (1) Low HDL is the earliest marker for insulin resistance in patients with early HCV 2) HCV causes insulin resistance regardless of patient's BMI. The identification of low HDL in early HCV suggests that an accurate and simple clinical marker for insulin resistance may be available so that intervention with insulin sensitizing therapies is initiated at the earliest.Table. Results
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call