Glucose metabolism changes in patients with chronic hepatitis C treated with direct acting antivirals

AutoriDrazilova S., Janicko M., Skladany L.,  Kristian P.,  Oltman M., Szantova M.,  Krkoska D.,  Mazuchova E., Piesecka L. Vahalova V., Rac M., Schreter I., Virag L., Koller T., Liptakova A., Ondrasova M., Jarcuska P.

Pracovisko: 1ST and 2nd Hepatology and Infectious Diseases Departments from Slovakia

V.interná klinika Lekárskej fakulty Univerzity Komenského a Univerzitná nemocnica Bratislava

Abstrakt:

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, most of them (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.