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To Investigate Prevalence of Diabetes Type 1 and Type 2 in HCV Infected Individuals

Sajida Parveen* and Sadia Anjum

NUST Pakistan, Atta-Ur-Rehman School of applied Biosciences, Islamabad, Pakistan

*Corresponding Author:
Sajida Parveen
NUST Pakistan
Atta-Ur-Rehman School of applied Biosciences
Islamabad, Federal, 44000, Pakistan
Tel: +92-0336-5375619
E-mail: [email protected]

Received date: April 20, 2016; Accepted date: May 18, 2016; Published date: May 25, 2016

Citation: Parveen S, Anjum S (2016) To Investigate Prevalence of Diabetes Type 1 and Type 2 in HCV Infected Individuals. Epidemiology (Sunnyvale) 6:246. doi:10.4172/2161-1165.1000246

Copyright: © 2016 Parveen S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

This study was aimed to investigate the prevalence of diabetes mellitus type 1 and 2 in patients infected with hepatitis C virus. This study was conducted in blood collection Centre at Nuclear Medicine Oncology and Radiotherapy Institute (NORI) situated in Islamabad, Pakistan. The duration of study was from March 2014 to June 2014 twice a week. Randomly selected 112 HCV infected patients were included in this study. Patient information form was used to collect information from patients. In addition to this, about 51 patients were tested for random blood glucose levels, by strip based glucose testing method. Our control group consisted of 80 non HCV infected individuals of same age group. The results of the present study showed 7/112 (6.25%) diabetic patients in HCV infected group and 9/80 (11%) in non-infected. Statistical analysis does not support association of diabetes type 2 with HCV infection (OR=0.5926, 95% of CI=0.2116 to 1.6594, P=0.3193). Similarly, when we analyzed diabetes type 1 separately, 3.57% were suffering from type 1 in HCV infected patients, contrary to that there was not a single person was suffering from type 1 diabetes. Statistically, it is insignificant with p value 0.2050. Although insulin resistance is often reported in HCV infection, however, association of diabetes type 2 with HCV seems rare event. Type 1 Diabetes mellitus is reported to be linked with antiviral therapy, but our results show insignificant association.

Keywords

Diabetes mellitus; Random blood glucose; Insulin resistance; Hyperglycemia; Glucose intolerance

Introduction

Hepatitis C virus (HCV) causes hepatitis C infection and is known as one of the leading cause of damages liver. This infection is asymptomatic and may remain over years without diagnosis. In case of chronic infection, liver disfigurement occurs eventually leading to liver fibrosis and liver cirrhosis. Even liver cirrhosis may remain unnoticed for number of years and finally develops into liver failure or liver carcinoma, or sometimes into esophageal and gastric abnormality [1].

About 3 percent of the world population is known to be suffering from this infectious disease in chronic form [2,3]. Studies show that approximately 3 to 4 million people get infected by HCV every year and above 350,000 people pass away per year due to hepatitis C infection and its complications [2].

There are a number of extra hepatic manifestations associated with HCV infection which include cryoglobulinemia (inflammation of small blood vessels) [4], associated Sjogren’s syndrome (autoimmune disease), thrombocytopenia, skin diseases, insulin resistance, diabetes mellitus; diabetic nephropathy, autoimmune thyroiditis and B-cell lymphoproliferative disorders [5].

Metabolic disorders involving hyperglycemia due to some defect in accomplishment of insulin or due to abnormal amount of insulin secretions or both problems occurring simultaneously is known as diabetes mellitus. Unrelieved hyperglycemia is known to be linked with prolonged functional deficiency and often leads to defect and malfunctioning of different organs, like nerves, heart, blood vessels, kidneys and eyes [6].

It is estimated that above 285 million people are living with the lifelong progressive diabetes mellitus (DM) worldwide [7]. Approximately, 6.4% of the total world’s population is known to be affected by DM; about 5-10% accounts for DM type 1, while rest of 90-95% accounts for DM type 2 [7].

Epidemiological surveys’ in as early as 1994 showed that HCV infection is somehow related with onset of diabetes in HCV infected patients. This conclusion was based on information obtained from approximately entire prior epidemiologic learning, incorporated a combination of patients infected with HCV, those with liver cirrhosis and those without liver cirrhosis [8]. Hepatitis C virus infection and type 2 diabetes being major health problems have a wide range of complications and their mortality rates are continuously increasing. HCV infection prompts diabetes. Cirrhosis and hematomas caused by HCV infection cause glucose intolerance and insulin [9].

Based on early clinical observation, type II diabetes mellitus (DM) was suggested to be another potential extrahepatic manifestation of HCV infection, with excess risk postulated to be due to either direct viral involvement or secondary to HCV-induced liver damage. However, even a small increase in DM risk in HCV-infected patients may be clinically important, as available pharmacotherapy for HCV are less effective with concomitant DM and progression of liver disease has been shown to be worsened [8].

The association between HCV infection and type 2 diabetes appears to be often linked, at least in predisposed individuals (older and overweight). The virus itself and not the liver disease may be the culprit by interfering with insulin signaling [10]. Clinically, longstanding insulin resistance, hyperglycemia and diabetes may worsen liver fibrosis. Whether it also reduces the efficacy of anti-viral treatment remains to be studied but this may be the case as overweight and steatosis associated with a lower response. Preliminary data suggest that correction of insulin resistance might help achieve higher response rates with anti-viral treatment [11].

Combined pegylated interferon (PEG-IFN) + ribavirin (RBV) therapy has been used as a primary treatment for chronic hepatitis C. However, IFN-induced autoimmune disease, including type 1 diabetes mellitus, has been highlighted as one of the problems with this therapy. A case study was conducted, in which patient developed DM 1 as a result of combined pegylated interferon + ribavirin therapy. It was treated by intensive insulin dosage initially and after completion of therapy, the dosage of insulin was gradually reduced from 22 U/day to 6 U/day. Prediction of onset of type 1 diabetes mellitus on the basis of baseline measurement of pancreas-associated auto antibodies is difficult. Therefore, it would be advisable to consider the possibility of onset of type 1 diabetes mellitus in all patients receiving IFN+RBV therapy [12].

Keeping in view above discussion this study is designed to investigate, at pilot scale, the association of Type-1 and Type-2 diabetes in HCV infected patients in our local population.

Materials and Methods

This is an epidemiological study to investigate prevalence of diabetic manifestation of HCV infection in Pakistan. This study was approved by Internal Control Board of NORI.

Institute/diagnostic lab

This study has been conducted in blood collection centre at Nuclear Medicine Oncology and Radiotherapy Institute (NORI) situated in Islamabad, Pakistan. This study is done from March 2014 to June 2014 twice a week.

Study group

Experimental group

Inclusion criterion: HCV positive, HBV negative, HIV negative.

Exclusion criterion: People without HCV infection.

Control group

Inclusion criterion: 25 years to 60 years.

Exclusion criterion: HCV positive, HBV positive, HIV positive.

Patient information and consent form

The patient information and consent form is attached in appendix. Our patient information and consent form included questions i.e., patient’s age, gender, duration of HCV diagnosis, diabetes, antiviral therapy and viral load.

Data collection

Randomly selected 112 patients who were coming to NORI blood collection centre for HCV diagnosis test were included in this study. These patients were in age range of 20 years to 60 years. History was taken from these patients to find out diabetic prevalence in HCV infection in Pakistan. Patient information form was designed according to study requirements and was used to collect information from patients. In addition to this, about 51 patients were tested for random blood glucose levels, by strip based glucose testing method.

Statistical analysis

Data analysis is done by using Odds Ratios software (Figure 1).

epidemiology-odds-ratio

Figure 1: Calculation of odds ratio (statistical analysis).

Formula

The odd ratio is the ratio of odds of the outcome in the two groups.

= (a / c)/(b / d)

= (a × d)/(b × c)

Where,

Cases with positive outcome:

Number of cases in exposed group=a

Number of cases in control group=c

Cases with negative outcome:

Number of cases in exposed group=b

Number of cases in control group=d

Confidence Interval:

Confidence interval (for 95%) is calculated using this formula:

Upper limit for 95% CI = e^[In (OR) +1.96 v [(1/a+1/b+1/c+1/d)]

Lower limit for 95% CI = e^[In (OR) +1.96 v [(1/a+1/b+1/c+1/d)]

Results

All the data collected through patient’s information was arranged in a Table (Table 1) with the help of which relation between HCV infection and diabetes was calculated. Further, prevalence of diabetic manifestations in HCV infected patients was determined. Out of 112 HCV infected patients, 12 patients were found to be diabetics. Out of 12 diabetic patients, 5 were those who had diabetes before HCV diagnosis. 6 patients developed diabetes after diagnosis of HCV infection. Out of these 64 patients developed diabetes after undergoing antiviral therapy (Interferon) for 6 months. Thus it may be diabetes mellitus type 1.

Sr. No. PRN No. Viral load Age/Gender Diagnosis Treatment Diabetes
1 011667/14 <3,000 40/Female 2 years Injection (1 year) No
2 011963/14 <3,000 30/Female 5-6 years 6 months No
3 012611/14 2.1 × 105 30/Male Recent No No
4 011958/14 6.4 × 104 45/Female 1 year No No
5 011942/14 <3,000 18/Male 2 years 4 months No
6 011933/14 2.5 × 106 62/Male 2 months No No
7 011929/14 1.4 × 104 40/Male 1 year No No
8 009004/13 <3,000 23/Male 5 years 6 months No
9 01168/14 8.9 × 104 30/Male 4 years No No
10 011198/13 <3,000 46/Female 7 years 6 months No
11 011671/14 7.6 × 106 50/Female 3 years 6 months No
12 012559/14 <3,000 48/Female 3-4 months Injection No
13 012573/14 1.5 × 106 40/Female 4 years No No
14 009496/13 <3,000 41/Female 1 year 6 months No
15 009589/12 <3,000 42/Male 1 year No No
16 012599/14 1.5 × 106 55/Female 2-3 years No No
17 012572/14 1.3 × 106 39/Male 1 month No No
18 012598/14 5.8 × 106 28/Male 3 months No No
19 013024/14 1.1 × 106 26/Female Not yet No No
20 013046/14 4.1 × 106 53/Female 5 years 6 months No
21 006718/14 28 41/Female 1 month 4 injection No
22 023138/12 <3,000 46/Female 4 years Injections No
23 013067/14 1.0 × 106 60/Female 3-4 years No No
24 003445/12 3.6 × 106 37/Female 4 years 1 year No
25 009565/11 9.0 × 104 26/Female 2 years 2 times Yes
26 013338/14 1.6 × 106 20/Male 2years No No
27 024484/13 <3,000 40/Female 1 year Injection No
28 013342/14 2.7 × 106 35/Female 1 year No No
29 013350/14 <3,000 42/Male 7 years Injection No
30 013339/14 1.0 × 106 52/Female recent No No
31 013347/14 2.9 × 104 45/Female recent No Yes
32 023177/13 6.3 × 106 40/Female 1 year No No
33 013351/14 7.4 × 104 25/Female 3 years Started No
34 013344/14 6.4 × 106 53/Female 13 years Injection No
35 013365/14 8.3 × 104 42/Male Recent No No
36 007415/14 <3,000 35/Female 3 years No No
37 007408/14 4.1 × 106 16/Female 1 month No No
38 007429/14 5.6 × 106 43/male 1 year Injection No
39 007431/14 <3,000 54/Female 4-5 years 60 Inj Yes
40 007420/14 5.9 × 104 45/Female 1/1.5 year No No
41 007444/14 3.9 × 104 27/Male 4 year No No
42 025271/09 <3,000 43/Female 7 years Inj. 1 year No
43 008107/14 <3,000 47/Female 1 year 6 month No
44 005503/12 1.3×104 52/Female 2 years No No
45 008134/14 1.0 ×104 34/female recent No No
46 008150/14 7.9 × 104 64/Male 1 year No No
47 008810/14 1.8 × 106 48/Female 5-6 months No No
48 008815/14 6.1 × 104 48/Female 6 months Inj. No
49 004313/13 7.4 × 103 31/Female 1 year No No
50 008829/14 4.9 × 106 43/Male 1 year No No
51 008842/14 <3,000 35/Male 1 year Inj. No
52 008849/14 <3,000 28/Male 2 years Inj. No
53 008139/09 <3,000 52/Male 4-5 years 6 months Yes
54 004931/11 9.3 × 106 37/Male 5 years No No
55 008857/14 1.1 × 106 25/Female recent No No
56 008864/14 9.9 × 103 55/Female 8 years No No
57 008865/14 <3,000 44/Male 7 years 6months No
58 008026/13 <3,000 38/Female 1 year 6 months No
59 008866/14 2.0 × 106 39/Male 5-6 years No No
60 008873/14 2.5 × 104 40/Female 2 months No Yes
61 008876/14 8.7 × 103 60/Female 8 years Inj. No
62 029644/12 <3,000 37/Female 2 years Inj. No
63 027047/12 1.2 × 104 51/Female 6 months Inj. No
64 013107/14 1.5 × 104 35/Male 2 months No No
65 013834/14 1.4 × 106 46/Male Recent No No
66 013827/14 2.6 × 106 Female 2-3 years No No
67 013839/14 1.7 × 106 45/Male recent No No
68 013840/14 2.5 × 106 47/Female 2 years 72 inj. No
69 013853/14 3.7 × 106 35/Male Recent  No No
70 011334/12 <3,000 30/Female 2 years 6 months No
71 013850/14 1.4 × 106 20/Male Recent No No
72 013860/14 <3,000 55/Female 4 years 6 months Yes
73 013883/14 <3,000 60/Female 5-6 months Started No
74 014069/14 <12 54/Male 3 months 14 inj. Yes
75 014078/14 2.8 × 106 39/Male recent No No
76 014077/14 7.3 × 106 19/Male recent No No
77 002628/14 3.1 × 106 50/Male 1 year Medicine Yes
78 014079/14 5.2 × 104 38/Female Recent No No
79 009718/12 8.2 × 106 27/Female 2 years 24, 72 inj. No
80 014080/14 2.5 × 106 42/Female recent No No
81 014087/14 1.0 × 106 40/Female 7 years 6 months Yes
82 014092/14 5.2 × 103 22/Female 4-5 months No No
83 014120/14 <3,000 40/Female 6 years 72 inj. No
84 014108/14 3.5 × 106 34/Male 1 year No No
85 006736/14 <3,000 30/Male 6 months 72 inj. No
86 014106/14 <3,000 49/Female 3 months 36 inj. No
87 014110/14 1.9 × 106 27/Female 1 month No No
88 014118/14 2.2 × 106 36/Male Recent No No
89 014120/14 1.4 × 106 43/Male 2 months 4 inj. No
90 014085/14 2.9 × 106 42/Male recent No No
91 014769/13 <3,000 40/Male 4 years 72 inj. No
92 001172/14 3.9 × 104 10/Male 5 months No No
93 004751/12 4.7 × 106 55/Female 3-4 years 72 inj. yes
94 014125/14 <3,000 36/Female 3-4 years Medicine No
95 001236/08 <3,000 51/Female 8 years No yes
96 021819/12 3.2 × 106 54/Male 4 years No No
97 003634/14 6.4 × 104 35/Female 1 year No No
98 001155/10 <3,000 52/Female 3 years 72 inj No
99 000449/10 3.9 × 106 54/Male 3 years 2 times No
100 014577/14 <3,000 49/Female 6-7 years 6 months No
101 014588/14 1.6 × 106 24/Female 6-7 months No No
102 014582/14 7.2 × 106 40/Female 10 months No No
103 014587/14 3.9 × 106 50/Female recent No No
104 014592/14 6.0 × 106 30/Female 4 years No No
105 007716/13 <3,000 43/Female 8 years No No
106 031328/13 <3,000 30/Male 4-5 years Inj No
107 N.A 9.9 × 103 28/female 1 month No No
108 N.A 4.4 × 106 26/male 1 year No No
109 N.A <3,000 45/female 1year 6 month No
110 N.A <3,000 24/female 1year 72 inj No
111 N.A 7.5 × 106 55/male 8 years 72 inj No
112 N.A <3,000 32/female 1year No Yes

Table 1: Data showing patient information such as age, gender, viral load, duration of HCV infection diagnosis, treatment history: Red color indicates data of diabetic patients.

During this study, 51 patients random glucose test was also performed in order to find the difference between glucose levels of those patients who were only HCV positive and those who were diabetic in addition to HCV infection. Out of 51 such patients, 6 patients were diabetic, and 2 were in pre diabetic state.

In order to make comparison of having diabetes between non-HCV infected and HCV infected individuals, control group of 75 healthy (non-HCV) individuals 25 to 60 years of age were included. In control group, 9 out of 75 individuals were having diabetes.

During this study, 51 patients random glucose test was also performed in order to find the difference between glucose levels of those patients who were only HCV positive and those who were diabetic in addition to HCV infection. Out of 51 such patients, 6 patients were diabetic, and 2 were in pre diabetic state. In order to make comparison of having diabetes between non-HCV infected and HCV infected individuals, control group of 75 healthy (non-HCV) individuals 25 to 60 years of age were included. In control group, 9 out of 75 individuals were having diabetes (Figures 2 and 3).

epidemiology-Bar-graph

Figure 2: Bar graph showing relation between HCV infection and Diabetes. P=0.3193, 95% CI=1.4478, Odds Ratio=0.5926; CI shows no association between HCV and Diabetes, P value greater than 0.05 shows insignificant difference in the two groups.

epidemiology-relation-between

Figure 3: Bar graph showing relation between HCV infection and Diabetes. P=0.2050, 95% CI=125.4 Odds Ratio=6.774; shows no association between HCV and Diabetes type 1, P value greater than 0.05 shows insignificant difference in the two groups.

Statistical Analysis

Odds Ratios software was used for statistical analysis of the collected data.

Diabetes mellitus type 2

Odds Ratio=0.5926

95 % CI=0.2116 to 1.6594

Z statistics=0.996

P value=0.3193

Result is statistically insignificant.

Diabetes mellitus type 1

Odds Ratio=6.6774

95% CI=0.3544 to 125.8031

Z statistics=1.268

P value=0.2050

Result is statistically insignificant.

Discussion

Many studies have shown the association of HCV infection with diabetes. 30% occurrence of diabetes in HCV infected patients have been reported [13].

Allison first time reported this link between HCV infection and diabetes, since then, several studies have been conducted in order to figure out the exact process behind this association [14]. Some mechanisms have been proposed to be responsible for this association like Insulin resistance, interference in signaling pathways and increased production of proinflammatory cytokines like TNF and IL-6 causing oxidative stress [15].

The results of the present study showed 7/112 (6.25%) (Table 3) diabetic patients in HCV infected group and 9/80 (11%) (Table 4) in healthy individuals comprised almost of the same group. In this study the observed frequency of diabetes type 2 was very less in HCV infected than in non-infected group.

Serial no. PRN no. Age/Gender Date of diagnosis Viral load Glucose Diabetes
1 013024/14 26/female Recent 1.1 × 105 118mg/dl No
2 013046/14 53/Female 5 years 4.1 × 106 89 mg/dl No
3 013056/14 27/Female Not yet <3,000 81 mg/dl No
4 006718/14 41/Female 1 month 28 137 mg/dl Yes
5 023138/12 46/Female 4 years <3,000 81 mg/dl No
6 013067/14 60/Female 3-4 years 1.0 × 105 95 mg/dl No
7 003445/12 37/Female 4 years 3.6 × 105 103 mg/dl No
8 009565/11 26/Female 2 years 9.0 × 104 66 mg/dl No
9 013338/14 20/Male 2years 1.6 × 106 84 mg/dl No
10 024484/13 40/Female 1 year <3,000 84 mg/dl No
11 013342/14 35/Female 1 year 2.7 × 105 83 mg/dl No
12 013350/14 42/Male 7 years <3,000 84 mg/dl No
13 013339/14 52/Female Recent 1.0 × 105 71 mg/dl No
14 013347/14 45/Female Recent 2.9 × 104 201 mg/dl Yes
15 023177/13 40/Female 1 year 6.3 × 105 95 mg/dl No
16 013351/14 25/Female 3 years 7.4 × 104 96 mg/dl No
17 013344/14 53/Female 13 years 6.4 × 105 142 mg/dl Pre-diabetic
18 013365/14 42/Male Recent 8.3 × 104 75 mg/dl No
19 013834/14 46/Male Recent 1.4 × 106 123 mg/dl No
20 013827/14 Female 2-3 years 2.6 × 105 91 mg/dl No
21 013839/14 45/Male Recent 1.7 × 105 216 mg/dl Pre-diabetic
22 013840/14 47/Female 2 years 2.5 × 106 113 mg/dl No
23 013841/14 36/Male 2 months <3,000 72 mg/dl No
24 013853/14 35/Male recent 3.7 × 106 68 mg/dl No
25 011334/12 30/Female 2 years <3,000 93 mg/dl No
26 013850/14 20/Male recent 1.4 × 106 84 mg/dl No
27 013876/14 45/Female Recent <3,000 85 mg/dl No
28 013860/14 55/Female 4 years <3,000 347 mg/dl Yes
29 013883/14 60/Female 5-6 months <3,000 133 mg/dl No
30 014069/14 54/Male 3 months <12 162 mg/dl Yes
31 014078/14 39/Male recent 2.8 × 105 85 mg/dl No
32 014077/14 19/Male recent 7.3 × 106 74 mg/dl No
33 002628/14 50/Male 1 year 3.1 × 106 225 mg/dl Yes
34 014079/14 38/Female Recent 5.2 × 104 83 mg/dl No
35 009718/12 27/Female 2 years 8.2 × 106 101 mg/dl No
36 014080/14 42/Female recent 2.5 × 106 85 mg/dl No
37 014087/14 40/Female 7 years 1.0 × 106 219 mg/dl Yes
38 014092/14 22/Female 4-5 months 5.2 × 103 88 mg/dl No
39 014102/14 40/Female 6 years <3,000 102 mg/dl No
40 014108/14 34/Male 1 year 3.5 × 106 77 mg/dl No
41 006736/14 30/Male 6 months <3,000 92 mg/dl No
42 014106/14 49/female 3 months <3,000 84 mg/dl No
43 014110/14 27/female 1 month 1.9 × 106 114 mg/dl No
44 014118/14 36/Male Recent 2.2 × 105 76 mg/dl No
45 014120/14 43/Male 2 months 1.4 × 106 75 mg/dl No
46 014085/14 42/Male Recent years 2.9 × 106 84 mg/dl No
47 014769/13 40/Male 4 years <3,000 79 mg/dl No
48 001172/14 10/Male 3-4 months 3.9 × 104 73 mg/dl No
49 004751/12 55/female 3-4 years 4.7 × 106 212 mg/dl Yes
50 014125/14 36/Female 3-4years <3,000 84 mg/dl No
51 021819/12 54/male 4 years 3.2 × 106 90 mg/dl No

Table 2: Data showing information of diabetic patients: red color, green color, yellow Colors represent type-1, type-2 and pretreatment type-1 respectively.

S No. PRN No. Viral load Age/Gender Diagnosis of HCV Treatment Diabetes Diabetes before/after HCV Diabetes type
1 009565/11 9.0 × 104 26/Female 2 years 2 years Yes After Type 1
2 013347/14 2.9 × 104 45/Female Recent No Yes After Type 2
3 007431/14 <3,000 54/Female 4-5 years 60 Inj Yes After Type 1
4 008139/09 <3,000 52/Male 4-5 years 6 months Yes Before Type 2
5 008873/14 2.5 × 104 40/Female 2 months No Yes Before Type 2
6 013860/14 <3,000 55/Female 4 years 6 months Yes Before Type 2
7 014069/14 <12 54/Male 3 months 14 inj Yes Before Type 2
8 002628/14 3.1 × 106 50/Male 1 year Medicine Yes Before Type 2
9 014087/14 1.0 × 106 40/Female 7 years 6 months Yes After Type 1
10 004751/12 4.7 × 106 55/Female 3-4 years 72 inj. Yes After Type 1
11 001236/08 <3,000 51/Female 8 years No Yes After Type 2
12 N.A <3,000 32/female 1year No Yes After Type 1

Table 3: Data showing information of diabetic patients: red color, green color, yellow color represents type-1, type-2 and pretreatment type-1 respectively.

Sr. No. Age Gender Diabetes
1 30 Female No
2 30 Female No
3 32 Male No
4 38 Male No
5 29 Female No
6 35 Female No
7 25 Male No
8 52 Male Yes
9 57 Male Yes
10 45 Female No
11 49 Female Yes
12 56 Female No
13 55 Male No
14 45 Female No
15 55 Female Yes
16 57 Male No
17 59 Male No
18 49 Female No
19 40 Female No
20 49 Male No
21 45 Female Yes
22 51 Male No
23 30 Male No
24 40 Female No
25 32 Female No
26 30 Female No
27 32 Male No
28 32 Female No
29 30 Male No
30 34 Male No
31 41 Male No
32 32 Male No
33 33 Male No
34 30 Female No
35 60 Male No
36 51 Female No
37 55 Female No
38 43 Male No
39 34 Female No
40 55 Male No
41 50 Female No
42 30 Male No
43 30 Male No
44 53 Male No
45 48 Female No
46 50 Male Yes
47 42 Female No
48 50 Male No
49 46 Male No
50 35 Female No
51 30 Female No
52 30 Female No
53 51 Female No
54 53 Female No
55 48 Female No
56 58 Male Yes
57 51 Male No
58 33 Male No
59 49 Female No
60 30 Female No
61 32 Female No
62 31 Female No
63 30 Female No
64 58 Male No
65 52 Female Yes
66 34 Male No
67 32 Male No
68 30 Male No
69 30 Female No
70 30 Female No
71 63 Male No
72 45 Female Yes
73 50 Male No
74 47 Female No
75 40 Female No
76 40 Male Yes
77 31 Female No
78 30 Male No
79 28 Female No
80 32 Female No

Table 4: Data showing age, and diabetes status for control group, highlighted data shows diabetes condition (N=80).

Statistical analysis does not support association of diabetes type 2 with HCV infection. Odds ratio of diabetes/non diabetes in HCV/non HCV group being less than 1 does not support association between HCV infections. The observed P value for diabetes type 2 was 0.3193, which indicates no association.

This association of occurrence of diabetes due to HCV infection is not established; some studies proposed that HCV infection might be responsible of diabetes development in HCV infected individuals however, contradictory results are not uncommon.

Presence of HCV markers were not responsible for increased odds of diabetes but elevated liver enzyme activities were might be associated with increased odds of diabetes [16].

A recent report from America concluded no association of diabetes with HCV infection. Previous studies that reported associations between HCV infection and diabetes can be attributed to elevated levels of liver enzymes. However another Recent report from Pakistan showed Very high association of diabetes with HCV infection at liver cirrhotic stage (P=0.01) and no association at chronic non cirrhotic stage of infection (OR=2.005, 95% CI: 1.15, 3.43). Most of our patients were either chronic or the disease stage information was not clear, possibly the selection of chronic HCV patient had led to our results showing no association [15].

Similarly, when we analyzed diabetes type 1 separately, 3.57% was suffering from type 1 in HCV infected patients, contrary to that there was not a single person was suffering from type 1 diabetes. In HCV infection population slight increased. Statistically, it is insignificant with p value 0.2050. Our results are not in accordance with the previous reports which clearly designate association of Type 1 diabetes as side effect of the treatment [12]. However, this is a small scale study and the data presented is not conclusive. HCV positive patients (n=51) were tested for their random glucose level, 6 patients were diabetic and 2 patients random glucose level was in pre-diabetic range (Table 2).

Conclusion

Although insulin resistance is often reported in HCV infection, however, association of diabetes type 2 with HCV seems rare event. In present study, there is no significant association between HCV infection and Diabetes mellitus type 2.It remains to be determined whether HCV infection leads to diabetes type 2 or vice versa. Type 1 Diabetes mellitus is reported to be linked with antiviral therapy, but our results show insignificant association. However, this is a small scale study and the data presented is not conclusive.

Future Prospects

We further intend to evaluate Insulin Resistance in non-diabetic pathway in detail. We recommend studying type 1 diabetes marker in HCV patients, so that some alternative therapy could be recommended for predisposed patients. It is necessary to screen and control earlier for the presence of type 1 and type 2 diabetes mellitus.

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  1. Tammie Beasley
    Posted on Oct 03 2016 at 2:13 pm
    The article represents the results of a study that was conducted to understand the association between HCV infection and occurrence of diabetes. The results are interesting. Further in detail analysis is mandatory to unravel the exact role of antiviral therapy and occurrence of diabetes.
 

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