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Liver Int. 2018 Dec 20. doi: 10.1111/liv.14031. [Epub ahead of print]

Sustained virological response does not improve long-term glycemic control in patients with type 2 diabetes and chronic hepatitis C.

Author information

1
Department of Public Health Sciences, Henry Ford Health System, Detroit, MI.
2
Division of Gastroenterology and Hepatology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, MI.
3
Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI.
4
Division of Viral Hepatitis, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
5
Department of Epidemiology& Health Services Research, Geisinger Clinic, Danville, PA.
6
Center for Health Research, Kaiser Permanente-Northwest, Portland, OR.
7
Center for Health Research, Kaiser Permanente-Hawai'i,, Honolulu, HI.

Abstract

BACKGROUND:

Sustained virological response (SVR) to treatment for chronic hepatitis C (HCV) may improve short-term glucose control among patients with type 2 diabetes (T2D), but the long-term impact remains largely unknown. We used data from the Chronic Hepatitis Cohort Study to investigate the impact of SVR on long-term trends in HbA1c in patients with T2D.

METHODS:

"Index date" was defined as the date of treatment initiation (treated patients) or HCV diagnosis (untreated patients). To address treatment selection bias, we used a propensity score approach. We used a piecewise, linear-spline, mixed-effects model to evaluate changes in HbA1c over a five-year period.

RESULTS:

Our sample included 384 HCV patients with T2D (192 untreated, 192 treated, with SVR or treatment failure [TF]). After adjusting for BMI, HbA1c was stable among untreated and TF patients. In SVR patients, Hb1Ac trajectories evolved in three phases: 1) index through 6 months post-index, average HbA1c decreased significantly from 7.7-5.4% per 90 days (p<0.001); 2) 6-30 months post-index, HbA1c rebounded at a rate of 1.5% every 90 days (p=0.003); and 3) from 30 months onward, HbA1c stabilized at an average level of 7.9 (p-value =0.34). Results from an analysis restricted to patients receiving direct-acting antivirals were consistent with the main findings.

CONCLUSION:

Successful HCV treatment among patients with T2D significantly reduces HbA1 shortly after treatment, but these decreases are not sustained long-term. Less than three years after SVR, HbA1c rebounds to levels similar to untreated/TF patients, and higher than recommended for type 2 diabetic maintenance. This article is protected by copyright. All rights reserved.

KEYWORDS:

CHeCS; direct acting antiviral DAA; glycemic control; hemoglobin A1c; interferon

PMID:
30570808
DOI:
10.1111/liv.14031

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