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Improvement in Glycemic Control of Type 2 Diabetes After Successful Treatment of Hepatitis C Virus
Hum J, et al .
Diabetes Care 2017;40:1173–1180.

OBJECTIVE: HCV infection is associated with diabetes and may worsen glycemic control in patients with diabetes. We aimed to investigate whether eradication of HCV infection with direct-acting antiviral (DAA) agents is associated with improved glycemic control in patients with diabetes.

RESEARCH DESIGN AND METHODS: We identified 2,435 patients with diabetes who underwent interferon-free and ribavirin-free DAA-based antiviral treatment for HCV in the national Veterans Affairs health care system. Changes in average hemoglobin A1c (HbA1c) level and use of antidiabetic medications 1 year before and after antiviral treatment were compared between patients who achieved sustained virologic response (SVR) and those who did not.

RESULTS: Among patients with elevated baseline HbA1c, the drop in HbA1c associated with antiviral treatment was greater in those who achieved SVR (0.98%) than in those who sustained treatment failure (0.65%) (adjusted mean difference 0.34, P = 0.02).Use of antidiabetic medications decreased more in patients who achieved SVR than in those who sustained treatment failure, especially for the use of insulin, which dropped significantly from 41.3% to 38% in patients achieving SVR compared with a slight increase from 49.8% to 51% in those who sustained treatment failure.

CONCLUSIONS: DAA-based eradication of HCV is associated with improved glycemic control in patients with diabetes as evidenced by decreased mean HbA1c and decreased insulin use. These endocrine benefits of SVR provide additional justification for considering antiviral treatment in all patients with diabetes.

Expert's Commentary

« The association of type 2 diabetes (T2DM) with hepatitis C virus (HCV) infection is relatively common. T2DM is nearly four times more likely to develop in patients with HCV than in those without. Hence, treatment of HCV has the potential to impact a large percentage of the population, not only with respect to liver disease but also diabetes control. Hum et al analyzed 2435 patients with HCV and T2DM treated with interferon-free and ribavirin-free regimens and showed that eradication of HCV with DAA therapy led to improved glycemic control in T2DM patients. HbA1c values decreased and the percentage of patients receiving insulin decreased in patients who achieved SVR compared with those in whom treatment failed. Therefore, prompt HCV treatment could potentially slow the onset and progression of microvascular diabetes complications. The study has some limitations: additional medications received outside the Veterans Administration were not assessed, and follow-up after HCV eradication was short. The study was not able to evaluate whether improved glycemic control lasted beyond the 15-month period after completion of antiviral treatment and whether the effects subsequently led to reductions in the long-term risk of diabetic complications.
In summary, the good news is that SVR is associated with endocrine benefits in patients with HCV and T2DM, providing additional justification for considering antiviral treatment in all patients with diabetes. However, further studies are needed to determine the net effect of HCV eradication on long-term cardiovascular risk. »

Pr Maria Butti, Hospital General Universitari Valle Hebron, Barcelona

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