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© 2004 by the American Diabetes Association, Inc.
Pathophysiology/Complications |
High Prevalence of Glucose Abnormalities in Patients With Hepatitis C Virus Infection
A multivariate analysis considering the liver injury
1 Diabetes Research Unit, (Division of Endocrinology), Hospital Universitari Vall d’Hebron, Barcelona, Spain
2 Liver Unit, Hospital Universitari Vall d’Hebron, Barcelona, Spain
3 Department of Biochemistry, Hospital Universitari Vall d’Hebron, Barcelona, Spain
Address correspondence and reprint requests to Dr. Rafael Simó, Diabetes Research Unit, Hospital General Universitari Vall d’Hebron, Pg Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail: rsimo{at}hg.vhebron.es
OBJECTIVE—The aim of this study was to compare the prevalence of both impaired fasting glucose (IFG) and diabetes between hepatitis C virus (HCV)-infected patients and patients with other liver diseases but anti-HCV–, taking into account the degree of liver damage.
RESEARCH DESIGN AND METHODS—A total of 642 consecutive patients attending the outpatient liver unit of a university hospital (498 anti-HCV+ and 144 anti-HCV–) were prospectively recruited. Patients were classified as having chronic hepatitis (n = 472) or cirrhosis (n = 170) by means of the result of either a liver biopsy or by typical clinical features. A logistic regression model was used to determine independent associations of covariates (age, sex, BMI, HCV antibody status, and triglycerides) with the presence of glucose abnormalities.
RESULTS—A threefold increase in the prevalence of glucose abnormalities was observed in HCV+ patients with chronic hepatitis in comparison with HCV– subjects (32 vs. 12%; P = 0.0003). In contrast, among patients with cirrhosis, although both diabetes and IFG were more prevalent in anti-HCV+ patients (40%) than in anti-HCV– patients (36%), the differences were not statistically significant. Finally, the logistic regression analysis showed that HCV infection was independently related to glucose abnormalities in those patients with chronic hepatitis (odds ratio 4.26 [95% CI 2.03–8.93]). In contrast, HCV was not an independent predictor of glucose abnormalities in cirrhotic patients.
CONCLUSIONS—The high prevalence of IFG and diabetes found in HCV-infected patients observed in our study suggests that screening for glucose abnormalities should be indicated in these patients. In addition, we provide evidence that the genuine connection between HCV infection and diabetes is initiated at early stages of hepatic disease.
Abbreviations: ALT, alanine aminotransferase • AST, aspartate aminotransferase • HCV, hepatitis C virus • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • NHANES III, Third National Health and Nutrition Examination Survey • OGTT, oral glucose tolerance test
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