Early treatment and elimination of hepatitis C virus (HCV) with direct-antiviral agents (DAAs) in patients with related cirrhosis may improve glucose tolerance and reduce the risk for diabetes development, according to findings from a prospective study published in Liver International.1
Investigators evaluated the impact of DAAs on glucose control in people without diabetes with HCV genotypes 1a/1b and cirrhosis. Glucose tolerance was assessed by a 2-hour 75-gram glucose tolerance test, with impaired glucose tolerance defined as plasma glucose of 140 to 199 mg/dL. A total of 32 consecutive outpatients were included and were evaluated at 12 weeks following treatment with a DAA. In addition, researchers estimated each patient’s insulin resistance using the oral glucose insulin sensitivity index.
At the end of the 12-week DAA treatment, all patients had achieved sustained virologic response. Although no significant changes were observed in fasting plasma glucose following viral eradication (103.5±7.1 vs 102.8±7.2 mg/dL, P =.15), there was a significant reduction in 2-hour plasma glucose level from baseline (165.2±22.7 vs 138.5±21.3 mg/dL, P <.001).
In addition, hemoglobin A1c levels decreased significantly after viral elimination (6.1±0.2% vs 5.7±0.3%, P <.001). The oral glucose insulin sensitivity index also demonstrated a strong reduction in insulin resistance at 12-week follow-up (6.92±1.56 vs 9.52±1.39 mg/kg/min, P <.001).
Although the findings of this study demonstrate the potential advantage of HCV eradication with DAAs for reducing diabetes risk, additional research with a longer follow-up period may provide greater insight into the benefits and possible risks associated with treatment in this patient population.
The investigators believe that the findings obtained from their study emphasize “that glucose tolerance is an independent predictor of overall mortality and hepatic decompensation in patients with HCV-cirrhosis.”2
- Salomone F, Catania M, Montineri A, et al. Hepatitis C virus eradication by direct antiviral agents improves glucose tolerance and reduces post-load insulin resistance in nondiabetic patients with genotype 1 [published online December 19, 2017]. Liver Int. doi: 10.1111/liv.13669.
- Calzadilla-Bertot L, Vilar-Gomez E, Torres-Gonzalez A, et al. Impaired glucose metabolism increases risk of hepatic decompensation and death in patients with compensated hepatitis C virus-related cirrhosis. Dig Liver Dis. 2016;48(3):283-290.