HCV eradication improves glucose metabolism even without DM

  • Gualerzi A & al.
  • PLoS One
  • 1 Jan 2018

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Eradication of HCV improves glucose metabolism regardless of diabetes mellitus (DM) status.

Why this matters

  • Viral-induced insulin resistance is linked to liver fibrosis progression.

Study design

  • Study population was 82 HCV-RNA-positive patients without known diabetes, receiving direct antivirals.
  • All underwent a standard oral glucose tolerance test before and immediately after antiviral treatment.
  • Funding: None.

Key results

  • At treatment end, HCV-RNA quantification was below detection threshold in all cases.
  • Significant reductions from pre- to posttreatment occurred in:
    • Fasting plasma glucose: 94 to 92 mg/dL (P=.028); 
    • 2-hour postglucose load: 132 to 114 mg/dL (P<.001>
    • HbA1c: 5.5% to 5.4% (P=.008); and
    • Homeostasis model assessment of insulin resistance (HOMA-IR): 3.42 to 2.80 (P<.001>
  • Insulin Sensitivity Index according to Belfiore rose (0.49 to 0.64; P<.001 despite significantly decreased insulin secretion measured by early first phase according to stumvoll>
  • Pretreatment: 
    • 37 (45%) had normal glucose tolerance (NGT),
    • 31 (38%) prediabetes, and
    • 14 (17%) diabetes.
  • Posttreatment, those numbers were 53 (65%), 17 (21%), and 12 (15%), respectively.
  • HOMA-IR decreased significantly even among the 37 with baseline NGT (P=.017).

Limitations

  • Small sample size.
  • Many had advanced liver disease (52% cirrhosis; 38% advanced liver fibrosis).
  • Heterogeneity of viral genotypes.
  • Short-term.