Justine Hum1, Janice H Jou1, Pamela K Green2, Kristin Berry2, James Lundblad3, Barbara D Hettinger3, Michael Chang1, George N Ioannou4,5. 1. Division of Gastroenterology, Portland Veterans Affairs Medical Center, Portland, OR. 2. Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA. 3. Division of Endocrinology, Portland Veterans Affairs Medical Center, Portland, OR. 4. Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle, WA georgei@medicine.washington.edu. 5. Division of Gastroenterology, Veterans Affairs Puget Sound Healthcare System and University of Washington, Seattle, WA.
Abstract
OBJECTIVE: Hepatitis C virus (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.
OBJECTIVE:Hepatitis C virus (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.
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Authors: Jia Li; Stuart C Gordon; Loralee B Rupp; Talan Zhang; Sheri Trudeau; Scott D Holmberg; Anne C Moorman; Philip R Spradling; Eyasu H Teshale; Joseph A Boscarino; Mark A Schmidt; Yihe G Daida; Mei Lu Journal: Liver Int Date: 2019-01-24 Impact factor: 5.828
Authors: George N Ioannou; Lauren A Beste; Pamela K Green; Amit G Singal; Elliot B Tapper; Akbar K Waljee; Richard K Sterling; Jordan J Feld; David E Kaplan; Tamar H Taddei; Kristin Berry Journal: Gastroenterology Date: 2019-07-26 Impact factor: 22.682