Reduced incidence of type 2 diabetes in patients with chronic hepatitis C virus infection cleared by direct-acting antiviral therapy: A prospective study

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.