EVIDENCE FOR A LINK BETWEEN HEPATITIS-C VIRUS-INFECTION AND DIABETES-MELLITUS IN A CIRRHOTIC POPULATION

Abnormalities of carbohydrate metabolism, including hyperinsulinaemia and insulin resistance, are well recognised complications of cirrhosis . While diabetes mellitus can be explained in many instances on the ba sis of coincident pancreatic disease, in most the characteristic gluco se intolerance of cirrhosis is not readily explicable. A previous clin ical observation that hepatitis C virus infection and diabetes mellitu s appeared to be associated was formally tested by a retrospective rev iew of 100 consecutive adult patients with cirrhosis undergoing assess ment for liver transplantation. Hepatitis C virus was diagnosed by con ventional serological and histological criteria. Twenty-three patients had diabetes mellitus, of whom 18 were being treated with insulin. Of the 34 patients with hepatitis C virus-related cirrhosis, 17 (50%) ha d diabetes mellitus, in contrast to just six (9%) of the 66 patients w ith cirrhosis unrelated to hepatitis C virus (chi(2)=19.1, p<0.0001) w ith an odds ratio for hepatitis C virus by diabetes mellitus status 10 .0 (95% confidence interval 3.4 to 29.3). Hierarchical loglinear model analysis of those factors of potential relevance to the development o f diabetes mellitus revealed that only hepatitis C virus interacted si gnificantly with diabetes mellitus while the relation between diabetes mellitus and origin, sex, body mass index and severity of cirrhosis w as conditional. By multiple logistic regression analysis of diabetes m ellitus status in relation to the same variables, only hepatitis C vir us status was statistically significant (p<0.0001). Origin, sex, sever ity of cirrhosis, body mass index and therapy were not significantly a ssociated. We conclude that there is a significantly increased rate of diabetes mellitus in patients with hepatitis C virus-related cirrhosi s compared with other causes, and further studies to confirm these fin dings and to elucidate the underlying mechanisms are underway. (C) Jou rnal of Hepatology.