Generic placeholder image

Current Diabetes Reviews

Author(s): Hany Aly Hussein, Ahmed Samir Allam* and Ahmed Samir Abdel Moaty

DOI: 10.2174/1573399815666190531091128

DownloadDownload PDF Flyer Cite As
Evaluation of Glycated Haemoglobin (HbA1c) Level in Type 2 Diabetic Chronic HCV Non-cirrhotic Treatment-Naïve Egyptian Patients Eradicated with Sofosbuvir Plus Daclatasvir

Page: [165 - 170] Pages: 6

  • * (Excluding Mailing and Handling)

Abstract

Background /Introduction: A high prevalence of type 2 diabetes mellitus (T2DM) was seen in association with hepatitis C virus infection; moreover, risk of development of T2DM is increased about 11 folds in patients with risk factors for metabolic syndrome in the presence of chronic hepatitis C virus (HCV) infection. There is a few available data on the effect of HCV eradication by the new direct-acting antiviral drugs (DAAs) on the glycemic control; hence the aim of our study is to evaluate the glycated haemoglobin (HbA1c) level changes in type 2 diabetic chronic HCV non cirrhotic treatment-naïve Egyptian patients after eradication with sofosbuvir (SOV) plus daclatasvir (DCV).

Patients and Methods: A prospective observational cross-sectional study, included 128 type 2 diabetic HCV patients with easy to treat criteria (non cirrhotic treatment-naïve patients with the following liver biochemical markers; total serum bilirubin ≤ 1.2 mg/dl, serum albumin ≥ 3.5 g/dl, INR≤ 1.2 and Platelet count≥ 150.000/mm3); according to the protocol of the Egyptian National Committee for Controlling HCV and the guidelines of the European Association for the Study of the Liver. HbA1c was done for all patients enrolled in the study before starting antiviral treatment, at the end of treatment and 3 months (12 weeks) after the end of treatment to patients who achieved sustained virological response (SVR) 12 only.

Results: According to their antidiabetic medications, patients were classified to Group I: 70 patients taking oral hypoglycemic drugs, Group II: 58 patients taking insulin therapy +/- oral hypoglycemic drugs. Regarding the glycemic profile, a statistically significant decrease of mean HbA1c % values was found in the studied patients (n=128), over the period of the study with p-value < 0.05. For better evaluation of improvement of glycemic control, we used a composite endpoint given by the reduction of HbA1c % (of a minimum of 0.5%). The endpoint was reached to 79% (101 patients) of all studied patients 3 months after the end of treatment. 75.7% (53 patients) reached the endpoint in group I, while 82.75 % (48 patients) of group II reached the endpoint 3 months after the end of treatment.

Conclusion: This study supports the idea that HCV eradication leads to a reduction in HbA1c in patients with diabetes, which could delay the onset and progression of microvascular diabetes complications.

Keywords: HCV, non cirrhotic, direct-acting antiviral drugs, sustained virological response, diabetes mellitus, glycated hemoglobin.

[1]
Lecube A, Hernández C, Genescà J and, Simó R. Glucose abnormalities in patients with hepatitis C virus infection: epidemiology and pathogenesis. Diabetes Care 2006; 29: 1140-9.
[2]
Antonelli A, Ferrari SM, Giuggioli D, et al. Hepatitis C virus infection and and type 2 diabetes mellitus. World J Diabetes 2014; 5: 586-600.
[3]
Mehta SH, Brancati FL, Strathdee SA, et al. Hepatitis C virus infection and incident type 2 diabetes. Hepatology 2003; 38: 50-6.
[4]
El-Khayat H, Fouad Y, Mohamed HI, et al. Sofosbuvir plus daclatasvir with or without ribavirin in 551 patients with hepatitis C-related cirrhosis, genotype 4. Aliment Pharmacol Ther 2018; 47: 674-9.
[5]
Lecube A, Hernández C, Genescà J, Simó R. Proinflammatory cytokines, insulin resistance, and insulin secretion in chronic hepatitis C patients: a case-control study. Diabetes Care 2006; 29: 1096-101.
[6]
Kawaguchi T, Ide T, Taniguchi E, et al. Clearance of HCV improves insulin resistance, beta-cell function, and hepatic expression of insulin receptor substrate 1 and 2. Am J Gastroenterol 2007; 102: 570-6.
[7]
World Health Organization. Global hepatitis report 2017.http://apps.who.int/iris/bitstream/10665/255016/1/9789241565455-eng.pdf?ua=1
[8]
Romero-Gómez M. Insulin resistance and hepatitis C. World J Gastroenterol 2006; 12: 7075-80.
[9]
Grancini V, Trombetta M, Lunati ME, et al. Contribution of β-cell dysfunction and insulin resistance to cirrhosis-associated diabetes: Role of severity of liver disease. J Hepatol 2015; 63: 1484-90.
[10]
EASL Recommendations on treatment of hepatitis C. J Hepatol 2017; 66(1): 153-94.
[11]
Zeuzem S, Heathcote EJ, Shiffman ML, et al. Twelve weeks of follow-up is sufficient for the determination of sustained virologic response in patients treated with interferon alpha for chronic hepatitis C. J Hepatol 2003; 39: 106-11.
[12]
World Health Organization. Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation. Geneva, Switzerland: World Health Organization 2011.
[13]
Ng V, Saab S. Effects of a sustained virologic response on outcomes of patients with chronic hepatitis C. Clin Gastroenterol Hepatol 2011; 9: 923-30.
[14]
Pavone P, Tieghi T, d’Ettorre G, et al. Rapid decline of fasting glucose in HCV diabetic patients treated with direct acting antiviral agents. Clinical Microbiology and Infection 2016; 22(5): 462.
[15]
Abdel Alem S, Elsharkawy A. fouad R., et al.. Improvement of glycemic state among responders to sofosbuvir- based treatment regimens: Single center experience. J Med Virol 2017; 89: 2181-7.
[16]
Harnois F, Msika S, Sabaté JM, et al. Prevalence and predictive factors of NASH in morbidly obese patients undergoing bariatric surgery. Obes Surg 2006; 16(2): 183-8.
[17]
Resmi Premji, Nira Roopnarinesingh, Nazia Qazi and, Eric S . Nylen. New-Onset Diabetes Mellitus with Exposure to Ledipasvir and Sofosbuvir. Journal of Investigative Medicine High Impact Case Reports 2015; 3(4)
[18]
Silva P. Kouyoumjian, Hiam Chemaitelly, Laith J. Abu-Raddad. Characterizing hepatitis C virus epidemiology in Egypt: systematic reviews, meta-analyses, and meta-regressions. Scientific Reports 2018; 8: Article number: 1661.