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Glycemic control improves with successful hepatitis C treatment
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Adults with diabetes treated for hepatitis C who achieve sustained virologic response after treatment with direct-acting antiviral agents experienced decreased HbA1c and decreased insulin use compared with those who did not achieve sustained virologic response, study data show.
George N. Ioannou, MD, MS, of the division of gastroenterology, VA Puget Sound Health Care System and University of Washington in Seattle, and colleagues evaluated data from the national VA health care system on 2,435 adults (mean age, 62.2 years; 97.5% men) with diabetes who underwent interferon-free and ribavirin-free direct-acting antiviral treatment for hepatitis C virus to determine whether treatment for HCV improves glycemic control.
Changes in HbA1c level and use of antidiabetes medication 1 year before and after antiviral treatment were compared between participants who achieved sustained virologic response (SVR; n = 2,180) and participants who did not.
Overall, 37.3% of participants had cirrhosis, 10.4% had decompensated cirrhosis, 75.2% of participants received at least one antidiabetes medication and 42.2% received insulin.
Participants who achieved SVR were less likely to have cirrhosis compared with participants who did not (35.3% vs. 54.5%) and were less likely to receive antidiabetes medications (74.8% vs. 78%) or insulin (41.3% vs. 49.8%).
Before treatment for HCV, HbA1c levels were similar in participants who did and did not achieve SVR. Participants who achieved SVR experienced a greater drop in average HbA1c level from 7.2% to 6.82% compared with participants who did not achieve SVR (7.27% to 7.08%). The decrease in HbA1c was greater in participants who achieved SVR (0.98%) compared with those who did not (0.65%) among participants with a pretreatment HbA1c level of 7.2% or less; however, researchers observed no significant difference between the participants for pretreatment HbA1c of 7.2% or less.
Participants who achieved SVR experienced a slight decrease in the number of classes of antidiabetes medications used and the proportion of patients receiving antidiabetes drugs, although the differences were not statistically significant.
The use of insulin decreased in participants who achieved SVR (41.3% to 38%) and slightly increased in those who did not (49.8% to 51%).
“Glycemic control improves in patients with diabetes after [direct-acting antiviral]-induced SVR,” the researchers wrote. “Patients not only have an improvement in HbA1c level after achieving SVR, they are also less likely to require insulin. These endocrine benefits of SVR provide additional justification for considering antiviral treatment in all patients with diabetes. Future studies are needed to confirm our findings, to determine how durable the SVR-induced improvement in glycemic control is over time, and to assess the long-term effect on complications of diabetes such as nephropathy, neuropathy and [cardiovascular disease].” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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