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


J Viral Hepat. 2018;25(8):952-958. 

In This Article


Among 14 312 patients with confirmed HCV in the CHeCS cohort, 7556 (53%) had received treatment and were hepatitis B-negative. Of these 7556 patients, 1048 were excluded for pre-existing diabetes, 809 for the ongoing antiviral treatment or unknown SVR status and 572 for having their last encounter date occur before the index date. This resulted in an analytic sample of 5127 treated patients; of these, 3748 (73%) achieved SVR (44% were treated with a direct-acting all-oral antiviral [DAA] regimen). A total of 530 incident cases of T2D (10.3%) were observed during a mean follow-up period of 3.7 years.

Table 1 presents the characteristics of patients at the time of last treatment initiation, as well as the risk associated with baseline covariates and the impact of SVR on the development of T2D. Overall, 60% of patients were male and 72% were White, with an average age of 59. Baseline age, sex, race, body mass index (BMI), Hispanic ethnicity, the presence of cirrhosis at baseline, and SVR all had individual effects on incidence of T2D. After multivariable modelling, six variables (age, race, BMI, cirrhosis at baseline, Hispanic ethnicity and SVR) were retained in the final model. No risk factor-by-SVR interactions were detected after adjustment.

Effect of SVR on Incidence of T2DM

After adjustment for baseline covariates, SVR reduced the risk of T2D by 21% (aHR = 0.79, 95% CI: 0.65–0.96, P = .02; Figures 1 and 2). There was no interaction between SVR and other risk factors, indicating an independent effect of SVR on incidence of T2D.

Figure 1.

Cumulative incidence of type 2 diabetes in patients who did and did not achieve sustained virologic response (SVR)

Figure 2.

Multivariate model of the impact of baseline covariates on the risk of type 2 diabetes

Effect of Additional Risk Factors on Incidence of T2DM

Higher BMI was associated with higher risk of incident T2D; in patients with BMI ≥ 30, the risk of T2D was almost 4 times higher than in patients with BMI <25 (aHR = 3.6; 95% CI: 2.2–5.95; Figure 2). Race was also associated with the risk of T2D; African American and Asian American, American Indian, or Pacific Islander (ASINPI) patients demonstrated risks 1.82-fold and 1.75-fold higher, respectively, than the White patients. There was no significant difference in the risk for T2D between African American and ASINPI patients. Risk increased with age. Hispanics had an almost two-fold higher risk than non-Hispanics. Patients with baseline cirrhosis demonstrated 1.5-fold higher risk of T2D than those without cirrhosis (Figure 3). The sensitivity analysis showed a nonsignificant effect of ALT on T2D development (P = 0.08).

Figure 3.

Cumulative incidence of type 2 diabetes in patients by age, BMI, cirrhosis status and hispanic ethnicity