Med. Allison et al., EVIDENCE FOR A LINK BETWEEN HEPATITIS-C VIRUS-INFECTION AND DIABETES-MELLITUS IN A CIRRHOTIC POPULATION, Journal of hepatology, 21(6), 1994, pp. 1135-1139
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.