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Observational Study
. 2018 Oct 3:2018:6095097.
doi: 10.1155/2018/6095097. eCollection 2018.

Glucose Metabolism Changes in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals

Sylvia Drazilova  1 , Martin Janicko  2 , Lubomir Skladany  3 , Pavol Kristian  4 , Marian Oltman  5 , Maria Szantova  6 , Dusan Krkoska  7 , Eva Mazuchova  7 , Lubica Piesecka  8 , Veronika Vahalova  8 , Marek Rac  9 , Ivan Schreter  4 , Ladislav Virag  4 , Tomas Koller  10 , Adriana Liptakova  11 , Miriam Ondrasova  12 , Peter Jarcuska  2
Affiliations
Observational Study

Glucose Metabolism Changes in Patients with Chronic Hepatitis C Treated with Direct Acting Antivirals

Sylvia Drazilova et al. Can J Gastroenterol Hepatol. .

Abstract

Background and aims: Chronic hepatitis C is a systemic disease and type 2 diabetes mellitus (T2DM) belongs to more common extrahepatic. The aim of this study was to (i) explore the prevalence of impaired fasting glucose (IFG) and T2DM in patients with chronic hepatitis C, (ii) explore the effect of direct acting antivirals (DAA) treatment on the glycemia, and (iii) explore the factors that modulate the effect of DAA treatment on glycemia in patients with chronic hepatitis C.

Methods: We performed a longitudinal retrospective observational study focused on the patients undergoing DAA treatment of chronic hepatitis C. Data about glycemia, history of diabetes, hepatitis C virus, treatment, and liver status, including elastography, were obtained at baseline (before treatment start), at the end of treatment and 12 weeks after the end of treatment. Patients were treated with various regimens of direct acting antivirals.

Results: We included 370 patients; 45.9% had F4 fibrosis. At baseline, the prevalence of T2DM increased with the degree of fibrosis (F0-F2 14.4%, F3 21.3%, and F4 31.8%, p=0.004). Fasting glycemia also increased with the degree of fibrosis (F0-F2 5.75±0.18 F3 5.84±0.17, and F4 6.69±0.2 mmol/L, p=0.001). We saw significant decrease of glycemia after treatment in all patients, but patients without T2DM or IFG from 6.21±0.12 to 6.08±0.15 mmol/L (p=0.002). The decrease was also visible in treatment experienced patients and patients with Child-Pugh A cirrhosis.

Conclusion: We confirmed that the prevalence of either T2DM or IFG increases in chronic hepatitis C patients with the degree of fibrosis. The predictive factors for T2DM were, besides F4, fibrosis also higher age and BMI. Significant decrease of fasting glycemia after the DAA treatment was observed in the whole cohort and in subgroups of patients with T2DM, IFG, cirrhotic, and treatment experienced patients.

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Figures

Figure 1
Figure 1
Correlation between fasting glycemia and APRI noninvasive score of fibrosis.
Figure 2
Figure 2
Changes of fasting glycemia with treatment in all patients and subgroups of patients with type 2 diabetes mellitus or impaired fasting glucose. EoT: end of treatment; EoT+12w: 12 weeks after the end of treatment.
Figure 3
Figure 3
Changes of fasting glycemia with treatment in naive and experienced patients in the whole group and separately for F4 fibrosis patients. EoT: end of treatment; EoT+12w: 12 weeks after the end of treatment.
Figure 4
Figure 4
Changes of fasting glycemia with treatment in the whole group and separately for F0-F2, F3, and F4 (Metavir) fibrosis patients. EoT: end of treatment; EoT+12w: 12 weeks after the end of treatment.
Figure 5
Figure 5
Changes of fasting glycemia with treatment in patients with Child-Pugh A and Child-Pugh B/C cirrhosis. EoT: end of treatment; EoT+12w: 12 weeks after the end of treatment.
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