Impact of Sustained Virologic Response on Risk of Type 2 Diabetes Among Hepatitis C Patients in the United States

J. Li; T. Zhang; S. C. Gordon; L. B. Rupp; S. Trudeau; S. D. Holmberg; A. C. Moorman; P. R. Spradling; E. H. Teshale; J. A. Boscarino; M. A. Schmidt; Y. G. Daida; M. Lu

Disclosures

J Viral Hepat. 2018;25(8):952-958. 

In This Article

Abstract and Introduction

Abstract

Data regarding the impact of hepatitis C (HCV) therapy on incidence of type 2 diabetes mellitus are limited. We used the data from the longitudinal Chronic Hepatitis Cohort Study–drawn from four large US health systems–to investigate how response to HCV treatment impacts the risk of subsequent diabetes. Among HCV patients without a history of type 2 diabetes mellitus or hepatitis B, we investigated the incidence of type 2 diabetes from 12 weeks post-HCV treatment through December 2015. Cox proportional hazards models were used to test the effect of treatment status (sustained virologic response [SVR] or treatment failure) and baseline risk factors on the development of diabetes, considering any possible risk factor-by-SVR interactions, and death as a competing risk. Among 5127 patients with an average follow-up of 3.7 years, diabetes incidence was significantly lower among patients who achieved SVR (231/3748; 6.2%) than among patients with treatment failure (299/1379; 21.7%; adjusted hazard ratio [aHR] = 0.79; 95% CI: 0.65–0.96). Risk of diabetes was higher among African American and Asian American patients than White patients (aHR = 1.82 and 1.75, respectively; P < .05), and among Hispanic patients than non-Hispanics (aHR = 1.86). Patients with BMI ≥ 30 and 25–30 (demonstrated higher risk of diabetes aHR = 3.62 and 1.72, respectively; P < .05) than those with BMI < 25; patients with cirrhosis at baseline had higher risk than those without cirrhosis (aHR = 1.47). Among a large US cohort of patients treated for HCV, patients who achieved SVR demonstrated a substantially lower risk for the development of type 2 diabetes mellitus than patients with treatment failure.

Introduction

Data regarding the impact of hepatitis C (HCV) therapy on incidence of type 2 diabetes mellitus (T2D) are limited. European studies from the interferon era of HCV therapy suggested that viral suppression and clearance greatly reduce the risk of future insulin resistance and T2D.[1–3] In contrast, other studies have found no significant difference in the incidence of T2D or insulin resistance between treated and untreated HCV patients.[4,5] There remains a lack of current data regarding the effect of HCV-related complications and treatment outcomes on the incidence of T2D in the United States, particularly among racially diverse populations.

We evaluated the impact of HCV treatment response, the presence of cirrhosis and other factors on the incidence of T2D using longitudinal data from the Chronic Hepatitis Cohort Study (CHeCS), a geographically and racially diverse cohort of over 13 000 patients from four large US health systems.

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