HIGH PREVALENCE OF DIABETES-MELLITUS IN PATIENTS WITH CHRONIC HEPATITIS-C - A CASE-CONTROL STUDY

Objectives and methods. - Extrahepatic manifestations have been report ed in hepatitis C virus infection. To assess the relationship between diabetes mellitus and hepatitis C virus, we studied 152 patients with chronic hepatitis C and 152 controls hospitalized during the same peri od with hepatitis B virus (n = 51) or alcohol-induced (n = 101) liver diseases matched for age, sex, and the presence of cirrhosis (prevalen ce: 58 %). Patients with jaundice, ascites, encephalopathy, prothrombi n activity < 65 %, or serum albumin < 35 g/L were excluded. Results. - Diabetes, defined by fasting serum glycemia > 1.4 g/L on at least two separate occasions or previously treated overt diabetes, was present in 38 patients with chronic hepatitis C (24 %) and in 13 patients in t he control group (9 %, P < 0.002). In the 51 diabetic patients, irresp ective of serum anti-hepatitis C virus status, 41 (81 %) had non insul in dependent diabetes and 45 (88 %) had cirrhosis. Family history of d iabetes or obesity was observed in 2 (5 %) of the diabetic patients wi th chronic hepatitis C and in 6 (46%) of the diabetic controls (P = 0. 002). Plasma C-peptide (855 +/- 448 pmol/L versus 1 152 +/- 491 pmol/L , NS) and insulin levels (83 +/- 40 pmol/L versus 184 +/- 86 pmol/L, N S), assayed in 17 diabetic patients with chronic hepatitis C and in 9 diabetic controls, were lower in the former. The prevalence of HLA B8, DR3 or DR4 antigens, which was searched for in 77 patients with chron ic hepatitis C, was not different in diabetic and non diabetic patient s, and, was similar to the reference population. Serum islet-cell anti bodies were found in 5 patients with chronic hepatitis C (3 with diabe tes) and in 2 controls. Conclusion. - Diabetes mellitus is more preval ent in patients with chronic hepatitis C than in patients with other l iver diseases, and usually occurs in the absence of predisposing facto rs. These results suggest a role of hepatitis C virus infection in the pathogenesis of diabetes.