The Best of Both Worlds: Impact of Remission of Hepatitis C on Glycemic Control in Patients With Type II Diabetes

Abstract

Introduction: Globally, chronic hepatitis C (CHC) is one of the major causes of chronic liver disease and cirrhosis. CHC is characterized by a high prevalence of metabolic derangements (HCADS- hepatitis C-associated dysmetabolic syndrome) that contributes to high morbidity and mortality. CHC is associated with higher risk of type 2 diabetes (T2DM) which is thought to due to hepatic insulin resistance induced by high levels of proinflammatory cytokines tumor necrosis factor- alfa (TNF-α) and Interleukin (IL-6). Thus, with sustained virological response (SVR) resulting in lower levels of proinflammatory cytokines, insulin resistance and glycemic control should improve. There are no published studies on the effect of SVR in patients with CHC using the new oral direct acting anti-viral (DAA) agents on glycemic control. We hypothesized that achieving an SVR using DAAs in the treatment of CHC would improve glycemic control in patients with T2DM. Methods: We performed a proof of concept study at a single center through a retrospective chart review of patients with CHC and T2DM who achieved SVR with DAAs. The primary endpoint was change in HbA1c. We also looked at other factors that could contribute to changes in HbA1c. Results: We found 180 patients with the diagnosis of CHC from 2014 through 2016, 12 had T2DM. DAAs resulted in SVR in 6 of these 12 patients with T2DM. The mean HbA1C was 9.9% before treatment, which decreased to 6.1% after SVR. Lifestyle or weight changes were not observed. Conclusion: There are numerous reports of higher risk of DM2 and insulin resistance with CHC, the impact of SVR with anti HCV therapy is largely unknown. This is the first observation of a significant improvement in HbA1c with SVR in CHC using DAAs. More importantly, a decrease in HbA1c occurred despite decrease in the anti-diabetic therapy. The improved glycemic control is likely due to SVR and not due to DAAs as this effect was sustained even after the therapy was stopped. Larger prospective trials are required to establish concrete association of SVR with improvement in glycemic control.Table: Table. Patient data