HCV and diabetes mellitus: Evidence for a negative association

Objective: Uncontrolled, retrospective clinical studies have recently claim ed that HCV infection could trigger the onset of diabetes mellitus (DM). We sought to verify the association between DM and liver diseases of differen t etiology, stage, and severity in a prospective study including gender- an d age-matched controls. Methods: Two hundred forty-seven patients with live r cirrhosis (184 men, 116 with an associated hepatocellular carcinoma, 34% in Child-Pugh's class A) were evaluated (group 1). One hundred fifty-seven (63.5) of them were HCV positive, 38 (15.5%) HBV positive, 49 (19.8%) alcoh ol abusers, and three (1.2%) cryptogenic. Two control groups were also incl uded. The first control group consisted of 138 patients with chronic hepati tis due to HCV infection (73.9%), HBV infection (15.9%), or alcohol abuse ( 10.2%) (group 2). The second control group included 494 patients with an ac ute osteoarticular trauma, age- and gender-matched with patients in group 1 (group 3). Results: Diabetes mellitus was present in 32.3%, 3.6%, and 9.7% of patients in groups 1, 2, and 3, respectively. When compared with contro ls (group 3), DM was significantly less frequent in group 2 (p < 0.004) and significantly more frequent in group 1 (p < 0.0001). The prevalence of DM was not different among patients with HCV, HBV infection, or alcohol abuse. In group 3, the prevalence of DM appeared to increase steadily with age. O n the contrary, in patients with liver cirrhosis (group 1) DM was detected in about 20-30% of cases in all decades of age. In group 2, diabetics were found only in the 7th and 8th decades of life. At multivariate analysis cir rhosis and age were the only two factors independently associated with DIM; odds ratios were 12.5 (95% confidence interval [C.I.], 6.74-20.4) for cirr hosis, and 1.47 for age (95% C.I. 0.39-2.55). Conclusions: Our findings dis prove HCV infection as a trigger factor for DM, which should not be listed among the various extrahepatic manifestations of this viral infection. (C) 1998 by Am. Coll. of Gastroenterology.