1. Reduced incidence of type 2 diabetes in patients with chronic hepatitis C virus infection cleared by direct-acting antiviral therapy: A prospective study
- Author
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Antonio Solano, Anna Ludovica Fracanzani, Ferdinando Carlo Sasso, Salvatore Petta, Pia Clara Pafundi, Antonio Craxì, Riccardo Nevola, Barbara Guerrera, Carmine Coppola, Vito Di Marco, Rosa Lombardi, Vincenzo Narciso, Aldo Marrone, Vincenza Calvaruso, Luigi Elio Adinolfi, Luca Rinaldi, Mariarosaria Saturnino, Mauro Giordano, Francesca Rini, Laura Staiano, Graziano Troina, Adinolfi L.E., Petta S., Fracanzani A.L., Nevola R., Coppola C., Narciso V., Rinaldi L., Calvaruso V., Pafundi P.C., Lombardi R., Staiano L., Di Marco V., Solano A., Marrone A., Saturnino M., Rini F., Guerrera B., Troina G., Giordano M., Craxi A., Sasso F.C., Adinolfi, Luigi E, Petta, Salvatore, Fracanzani, Anna L, Nevola, Riccardo, Coppola, Carmine, Narciso, Vincenzo, Rinaldi, Luca, Calvaruso, Vincenza, Pafundi, Pia Clara, Lombardi, Rosa, Staiano, Laura, Di Marco, Vito, Solano, Antonio, Marrone, Aldo, Saturnino, Mariarosaria, Rini, Francesca, Guerrera, Barbara, Troina, Graziano, Giordano, Mauro, Craxì, Antonio, and Sasso, Ferdinando C
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medicine.medical_specialty ,Cirrhosis ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Type 2 diabetes ,030204 cardiovascular system & hematology ,Antiviral Agents ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,chronic hepatiti ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Glucose homeostasis ,Prospective Studies ,Prospective cohort study ,direct-acting antiviral ,business.industry ,Incidence ,Incidence (epidemiology) ,nutritional and metabolic diseases ,Type 2 Diabetes Mellitus ,Hepatitis C, Chronic ,medicine.disease ,Diabetes Mellitus, Type 2 ,Case-Control Studies ,Relative risk ,HCV ,Population study ,type 2 diabetes ,business ,cirrhosi - Abstract
Aim HCV infection increases the risk of type 2 diabetes mellitus (T2DM). However, it remains still unclear whether HCV clearance by direct-acting antivirals (DAA) reduces T2DM. Therefore, the effect of HCV eradication on T2DM incidence was assessed. Methods A prospective multicenter case-control study was performed, which included 2,426 HCV patients, 42% of which with liver fibrosis F0-F2 and 58% F3-F4. Study population consisted of a control group including 1099 untreated patients and 1327 cases treated with DAA. T2DM incidence was assessed during a follow-up median period of 30 [IQR: 28-42] months. Risk factors of T2DM were assessed by Cox regression model (Relative risk (RR), Hazard risk (HR), Kaplan-Meier). Insulin sensitivity was evaluated by HOMA and changes by ANOVA for repeated measurements. Factors independently associated with T2DM were assessed by multivariate analysis RESULTS: The absolute incidence of T2DM/1,000 person-years for controls and cases was 28 and 7, respectively (p=0.001). In cases compared to controls, HCV clearance reduced the RR and HR of T2DM by 81% and 75-93% respectively (p = 0.001). It has been calculated that for every 15 patients who obtained HCV clearance one case of T2DM is saved. HCV clearance was associated with a significant reduction in HOMA-IR and HOMA- β and an increase in HOMA-S as assessed in 384 patients before and after HCV clearance. At multivariate analysis, HCV clearance emerged as independently associated with a reduced T2DM risk. Conclusion HCV clearance by DAA treatment reduces T2DM incidence more likely by restoring the HCV-induced alteration of glucose homeostasis mechanisms. This article is protected by copyright. All rights reserved.
- Published
- 2020