Do we need to screen for de-novo diabetes mellitus in chronic hepatitis C patients after a sustained virological response?

作者：Mousa Nasser; Abdel Razik Ahmed^*; Farag Raghda; Shabana Walaa; Elgamal Ayman; El Wakeel Niveen; Elzehery Rasha; Elkashef Wagdi; Eldars Waleed

来源：European Journal of Gastroenterology and Hepatology, 2017, 29(9): 1004-1009.

DOI：10.1097/MEG.0000000000000929

• BMI
• chronic hepatitis C
• de-novo diabetes mellitus
• homeostatic model assessment of insulin resistance
• leptin
• sustained virologic response

Background and aim There are millions of chronic hepatitis C (CHC) virus-infected patients who have been treated with a combination therapy (interferon and ribavirin) and have achieved a virological response (SVR) worldwide. The aim of this study is to evaluate the risk factors for de-novo diabetes mellitus in CHC patients treated with combination therapy (interferon and ribavirin) and have achieved an SVR.
Patients and methods A total of 214 nondiabetic CHC patients with SVR and baseline homeostasis model assessment (HOMA) less than or equal to 2 were divided into group A, which included 108 patients with a BMI less than 25, and group B, which included 106 patients with a BMI of at least 25 and less than 30. HOMA insulin resistance (IR) and BMI were measured at the baseline, at achievement of an SVR, and 1 year after achievement of an SVR. Leptin levels were assessed at baseline and 1 year after achievement of an SVR in patients with increased BMI.
Results One year after SVR, 36 (33.33%) patients from group A developed increasing BMI with no significant changes in HOMA versus that at SVR (P=0.53), but showed a significant reduction versus baseline HOMA (P=0.02)In group B, 68 (64.1%) patients showed increased BMI of at least 25, with a significant increase in HOMA versus that at SVR (P=0.02), and with no significant reduction versus baseline HOMA (P=0.44). In group B, serum leptin showed a significant reduction 12 months after achievement of an SVR versus baseline in patients with increased BMI. Six patients from group B with increased BMI after 1 year developed de-novo IR and type two diabetes mellitus.
Conclusion In nondiabetic CHC patients with SVR and baseline BMI of at least 25, the post-SVR increase in BMI predisposed to an increase in HOMA-IR and could be considered a predisposing factor for diabetes mellitus.

• 出版日期2017-9