Avoiding Diabetes in Patients With Hepatitis C

Epidemiologic data suggest that patients with chronic hepatitis C virus (HCV) infection have an increased risk for insulin resistance—and for overt diabetes.^1,2 Specifically, Serfaty and Capteau have reported evidence for “a triangular interaction” between steatosis, inflammatory processes, and insulin resistance.¹

Averting these metabolic risks is essential for several reasons: Most importantly, their development is associated with increased liver inflammation and progression to fibrosis and cirrhosis, as well as impaired response to antiviral medications.^3,4 Additionally, type 2 diabetes in patients with chronic HCV has been associated with a 1.7-fold increased risk for hepatocellular carcinoma (HCC) and other malignancies.^5,6

Though never directly linked with the metabolic syndrome, HCV has been associated with impaired insulin signaling and insulin resistance, in addition to hypocholesterolemia and steatosis. Lonardo et al went so far as to mark this constellation of effects as “a distinct HCV-associated dysmetabolic syndrome.” ⁴

The dysmetabolic syndrome places affected patients at increased risk for cardiovascular disease, according to Rzouq et al. Statins, they report, are safe and effective in patients with chronic HCV and appear to confer anti-HCV proliferative benefits, making them a potentially “life-saving therapy.”⁷

Because insulin resistance in the hepatic and peripheral tissues is at the very least “an obvious and significantly detrimental pathophysiologic feature of HCV infection,” Kawaguchi and Mazuta suggest that patients with chronic HCV be encouraged to follow the same dietary and lifestyle recommendations made to those with diabetes, obesity, and metabolic syndrome.² Maintaining a healthy body weight and following a reasonable regimen of diet and exercise help protect the liver in HCV-infected patients, whereas overweight and obesity, high cholesterol levels, and fatty liver are associated with accelerated liver damage.³

Continue for another component of diabetes risk reduction >>

Another component of diabetes risk reduction in patients with HCV is controlling hypertension.⁸ Of note, treatment with angiotensin-blocking agents has been associated with reduced liver fibrosis in HCV patients, compared with those receiving no antihypertensives or diuretics, vasodilators, or calcium channel antagonists.^8,9

Patients with HCV who do develop diabetes are advised against using insulin or a sulfonylurea (ie, glipizide, glimepiride, glyburide).² Metformin is considered a safer option, and its use has been linked to a reduced risk for HCC.^2,10 Diabetic patients with HCV can also reduce their risk for HCC by maintaining an A1C level below 7.0%, according to Arase et al.⁵

REFERENCES

1. Serfaty L, Capteau J. Hepatitis C, insulin resistance and diabetes: clinical and pathogenic data. Liver Int. 2009;29(suppl 2):13-25.

2. Kawaguchi Y, Mazuta T. Interaction between hepatitis C virus and metabolic factors. World J Gasterentol. 2014;20(11):2888-2901.

3. US Department of Veterans Affairs. Viral hepatitis: diet and nutrition. http://www.hepatitis.va.gov/patient/daily/diet/single-page.asp. Accessed May 26, 2015.

4. Lonardo A, Loria P, Carulli N. Dysmetabolic changes associated with HCV: a distinct syndrome? Intern Emerg Med. 2008;3(2):99-108.

5. Arase Y, Kobayashi M, Suzuki F, et al. Effect of type 2 diabetes on risk for malignancies includes hepatocellular carcinoma in chronic hepatitis C. Hepatology. 2013;57(3):964-973.

6. Takahashi H, Mizuta T, Eguchi Y, et al. Post-challenge hyperglycemia is a significant risk factor for the development of hepatocellular carcinoma in patients with chronic hepatitis C. J Gastroenterol. 2011;46(6):790-798.

7. Rzouq F, Alahdab F, Olyaee M. Statins and hepatitis C virus infection: an old therapy with new scope. Am J Med Sci. 2014;348(5):426-430.

8. Arase Y, Suzuki F, Suzuki Y, et al. Losartan reduces the onset of type 2 diabetes in hypertensive Japanese patients with chronic hepatitis C. J Med Virol. 2009;81(9):1584-1590.

9. Corey KE, Shah N, Misdraji J, et al. The effect of angiotensin-blocking agents on liver fibrosis in patients with hepatitis C. Liver Int. 2009; 29(5):748-753.

10. Harris K, Smith L. Safety and efficacy of metformin in patients with type 2 diabetes mellitus and chronic hepatitis C. Ann Pharmacother. 2013;47(10):1348-1352.

Epidemiologic data suggest that patients with chronic hepatitis C virus (HCV) infection have an increased risk for insulin resistance—and for overt diabetes.^1,2 Specifically, Serfaty and Capteau have reported evidence for “a triangular interaction” between steatosis, inflammatory processes, and insulin resistance.¹

Averting these metabolic risks is essential for several reasons: Most importantly, their development is associated with increased liver inflammation and progression to fibrosis and cirrhosis, as well as impaired response to antiviral medications.^3,4 Additionally, type 2 diabetes in patients with chronic HCV has been associated with a 1.7-fold increased risk for hepatocellular carcinoma (HCC) and other malignancies.^5,6

Though never directly linked with the metabolic syndrome, HCV has been associated with impaired insulin signaling and insulin resistance, in addition to hypocholesterolemia and steatosis. Lonardo et al went so far as to mark this constellation of effects as “a distinct HCV-associated dysmetabolic syndrome.” ⁴

The dysmetabolic syndrome places affected patients at increased risk for cardiovascular disease, according to Rzouq et al. Statins, they report, are safe and effective in patients with chronic HCV and appear to confer anti-HCV proliferative benefits, making them a potentially “life-saving therapy.”⁷

Because insulin resistance in the hepatic and peripheral tissues is at the very least “an obvious and significantly detrimental pathophysiologic feature of HCV infection,” Kawaguchi and Mazuta suggest that patients with chronic HCV be encouraged to follow the same dietary and lifestyle recommendations made to those with diabetes, obesity, and metabolic syndrome.² Maintaining a healthy body weight and following a reasonable regimen of diet and exercise help protect the liver in HCV-infected patients, whereas overweight and obesity, high cholesterol levels, and fatty liver are associated with accelerated liver damage.³

Continue for another component of diabetes risk reduction >>

Another component of diabetes risk reduction in patients with HCV is controlling hypertension.⁸ Of note, treatment with angiotensin-blocking agents has been associated with reduced liver fibrosis in HCV patients, compared with those receiving no antihypertensives or diuretics, vasodilators, or calcium channel antagonists.^8,9

Patients with HCV who do develop diabetes are advised against using insulin or a sulfonylurea (ie, glipizide, glimepiride, glyburide).² Metformin is considered a safer option, and its use has been linked to a reduced risk for HCC.^2,10 Diabetic patients with HCV can also reduce their risk for HCC by maintaining an A1C level below 7.0%, according to Arase et al.⁵

REFERENCES

1. Serfaty L, Capteau J. Hepatitis C, insulin resistance and diabetes: clinical and pathogenic data. Liver Int. 2009;29(suppl 2):13-25.

2. Kawaguchi Y, Mazuta T. Interaction between hepatitis C virus and metabolic factors. World J Gasterentol. 2014;20(11):2888-2901.

3. US Department of Veterans Affairs. Viral hepatitis: diet and nutrition. http://www.hepatitis.va.gov/patient/daily/diet/single-page.asp. Accessed May 26, 2015.

4. Lonardo A, Loria P, Carulli N. Dysmetabolic changes associated with HCV: a distinct syndrome? Intern Emerg Med. 2008;3(2):99-108.

5. Arase Y, Kobayashi M, Suzuki F, et al. Effect of type 2 diabetes on risk for malignancies includes hepatocellular carcinoma in chronic hepatitis C. Hepatology. 2013;57(3):964-973.

6. Takahashi H, Mizuta T, Eguchi Y, et al. Post-challenge hyperglycemia is a significant risk factor for the development of hepatocellular carcinoma in patients with chronic hepatitis C. J Gastroenterol. 2011;46(6):790-798.

7. Rzouq F, Alahdab F, Olyaee M. Statins and hepatitis C virus infection: an old therapy with new scope. Am J Med Sci. 2014;348(5):426-430.

8. Arase Y, Suzuki F, Suzuki Y, et al. Losartan reduces the onset of type 2 diabetes in hypertensive Japanese patients with chronic hepatitis C. J Med Virol. 2009;81(9):1584-1590.

9. Corey KE, Shah N, Misdraji J, et al. The effect of angiotensin-blocking agents on liver fibrosis in patients with hepatitis C. Liver Int. 2009; 29(5):748-753.

10. Harris K, Smith L. Safety and efficacy of metformin in patients with type 2 diabetes mellitus and chronic hepatitis C. Ann Pharmacother. 2013;47(10):1348-1352.

Epidemiologic data suggest that patients with chronic hepatitis C virus (HCV) infection have an increased risk for insulin resistance—and for overt diabetes.^1,2 Specifically, Serfaty and Capteau have reported evidence for “a triangular interaction” between steatosis, inflammatory processes, and insulin resistance.¹

Averting these metabolic risks is essential for several reasons: Most importantly, their development is associated with increased liver inflammation and progression to fibrosis and cirrhosis, as well as impaired response to antiviral medications.^3,4 Additionally, type 2 diabetes in patients with chronic HCV has been associated with a 1.7-fold increased risk for hepatocellular carcinoma (HCC) and other malignancies.^5,6

Though never directly linked with the metabolic syndrome, HCV has been associated with impaired insulin signaling and insulin resistance, in addition to hypocholesterolemia and steatosis. Lonardo et al went so far as to mark this constellation of effects as “a distinct HCV-associated dysmetabolic syndrome.” ⁴

The dysmetabolic syndrome places affected patients at increased risk for cardiovascular disease, according to Rzouq et al. Statins, they report, are safe and effective in patients with chronic HCV and appear to confer anti-HCV proliferative benefits, making them a potentially “life-saving therapy.”⁷

Because insulin resistance in the hepatic and peripheral tissues is at the very least “an obvious and significantly detrimental pathophysiologic feature of HCV infection,” Kawaguchi and Mazuta suggest that patients with chronic HCV be encouraged to follow the same dietary and lifestyle recommendations made to those with diabetes, obesity, and metabolic syndrome.² Maintaining a healthy body weight and following a reasonable regimen of diet and exercise help protect the liver in HCV-infected patients, whereas overweight and obesity, high cholesterol levels, and fatty liver are associated with accelerated liver damage.³

Continue for another component of diabetes risk reduction >>

Another component of diabetes risk reduction in patients with HCV is controlling hypertension.⁸ Of note, treatment with angiotensin-blocking agents has been associated with reduced liver fibrosis in HCV patients, compared with those receiving no antihypertensives or diuretics, vasodilators, or calcium channel antagonists.^8,9

Patients with HCV who do develop diabetes are advised against using insulin or a sulfonylurea (ie, glipizide, glimepiride, glyburide).² Metformin is considered a safer option, and its use has been linked to a reduced risk for HCC.^2,10 Diabetic patients with HCV can also reduce their risk for HCC by maintaining an A1C level below 7.0%, according to Arase et al.⁵

REFERENCES

1. Serfaty L, Capteau J. Hepatitis C, insulin resistance and diabetes: clinical and pathogenic data. Liver Int. 2009;29(suppl 2):13-25.

2. Kawaguchi Y, Mazuta T. Interaction between hepatitis C virus and metabolic factors. World J Gasterentol. 2014;20(11):2888-2901.

3. US Department of Veterans Affairs. Viral hepatitis: diet and nutrition. http://www.hepatitis.va.gov/patient/daily/diet/single-page.asp. Accessed May 26, 2015.

4. Lonardo A, Loria P, Carulli N. Dysmetabolic changes associated with HCV: a distinct syndrome? Intern Emerg Med. 2008;3(2):99-108.

5. Arase Y, Kobayashi M, Suzuki F, et al. Effect of type 2 diabetes on risk for malignancies includes hepatocellular carcinoma in chronic hepatitis C. Hepatology. 2013;57(3):964-973.

6. Takahashi H, Mizuta T, Eguchi Y, et al. Post-challenge hyperglycemia is a significant risk factor for the development of hepatocellular carcinoma in patients with chronic hepatitis C. J Gastroenterol. 2011;46(6):790-798.

7. Rzouq F, Alahdab F, Olyaee M. Statins and hepatitis C virus infection: an old therapy with new scope. Am J Med Sci. 2014;348(5):426-430.

8. Arase Y, Suzuki F, Suzuki Y, et al. Losartan reduces the onset of type 2 diabetes in hypertensive Japanese patients with chronic hepatitis C. J Med Virol. 2009;81(9):1584-1590.

9. Corey KE, Shah N, Misdraji J, et al. The effect of angiotensin-blocking agents on liver fibrosis in patients with hepatitis C. Liver Int. 2009; 29(5):748-753.

10. Harris K, Smith L. Safety and efficacy of metformin in patients with type 2 diabetes mellitus and chronic hepatitis C. Ann Pharmacother. 2013;47(10):1348-1352.