Does Sustained Virologic Response Improve Glycemic Control in HCV?

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Researchers compared HbA1c changes and use of antidiabetic medication in HCV with diabetes.

Eradicating hepatitis C virus (HCV) infection with direct-acting antiviral (DAA) agents in patients with diabetes reduced the amount of diabetic medication needed and significantly reduced the need for insulin, according to a study in Diabetes Care.

The researchers identified 2435 patients with diabetes who underwent DAA-based therapy in the Veterans Affairs healthcare system. Study investigators examined changes in patients’ average hemoglobin A1c (HbA1c) and antidiabetic medication use 1 year before and 1 year after HCV treatment.

Patients who responded successfully to treatment and achieved sustained virologic response decreased both HbA1c (0.98%) and use of antidiabetic medication — particularly insulin — the use of which decreased from 41.3% to 38%, compared with a slight increase in the use of insulin for those who still had HCV (49.8% to 51%).

Patients with well-controlled diabetes at baseline (HbA1c <7.2%) were more likely to eliminate insulin therapy following sustained virologic response.

The researchers also noted a greater drop in HbA1c among patients whose HCV was eradicated compared with patients who did not achieve a sustained virologic response.

Study investigators indicated that they were “unable to assess whether patients received additional medications outside the VA system,” and were unable to account for other changes such as improved diet and exercise that may have affected study results.

“DAA-based eradication of HCV is associated with improved glycemic control in patients with diabetes,” the researchers concluded. “These endocrine benefits of [sustained virologic response] provide additional justification for considering antiviral treatment in all patients with diabetes.”

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Hum J, Jou JH, Green PK et al. Improvement in glycemic control of type 2 diabetes after successful treatment of hepatitis C virus. Diabetes Care. 2017;40:1173-1180.