Hepatitis C virus infection, increased serum ferritin and hyperinsulinemia

Objectives: recent studies have reported a high prevalence of diabetes mell itus in populations infected with Virus C (HCV). The aim of this study is t wo-fold: a) to support the hypothesis of hyperinsulinemia as a risk factor for developing diabetes in these patients, with a prospective determination of baseline insulinemia in non-diabetic cirrhotic patients infected with H CV, comparing their values with those of a group of non-HCV non-diabetic ci rrhotic patients; b) to investigate in both groups the factors associated t o increased peripheral resistance to insulin. Material and methods: thirty two HCV cirrhotic diabetic patients (group I) and 41 non-diabetic cirrhotic patients of other etiologies (group II) parti cipated in the study. Baseline insulinemia, as well as factors related to i nsulin resistance such as age, anthropometric indexes, stage of cirrhosis d evelopment using the Child-Pugh index, serum ferritin and treatment with in sulin resistance inducing drugs were compared in both groups. Results: average baseline insulinemia in group I was 21.5 mU/ml (18.6-24.4) , vs 14 mU/ml (10-18) in group II (p <0.001), and the percentage of hyperin sulinemia was 87.5% (72.5-95.9) vs 56.1% (40.8-70.6), respectively (p <0.01 ). No differences were observed between the two groups when comparing the f ollowing variables: age [54.4 (48.3-60.6) vs 59.9 (56.3-62.7) years of age, NS], weight [72.9 (69.5-76.3) vs 74.2 (70.8-77.7) kg, NS], height [163.6 ( 160.5-166.7) vs 161.3 (159.4-163.2)] cm, NS], body mass index [27.6 (26.1-2 9.1) vs 28.4 (27.3-29.5) kg/m2 of height, NS]; and Child-Pugh staging score (A: 31 vs 27; B: 0 vs 7; C: 1 vs 7, NS). However, serum ferritin levels in group I patients were higher than those i n Group II [123.3 (12.4-289.3) vs 65.5 (2.4-306) ng/ml, p <0.05]. It must b e considered that at the recruitment 3 patients in Group I were taking eith er diuretics or non-selective beta-adrenergic blockers, compared to 14 pati ents in Group II, p <0.01. Finally, the multivariate logistic regression analysis showed that insuline mia values (OR=1.21; Cl 95% 1.09-1.34, p <0.001) and ferritin levels (OR=1. 21; CI 95% 1.02-2.69, p <0.04) were independent variables associated to HCV infection. Coclusions: HCV-positive non-diabetic cirrhotic patients have higher baseli ne insulinemia levels and increased prevalence of hyperinsulinemia than cir rhosis due to other etiologies. This could be explained by an increase of p eripheral insulin resistance, mediated by the increase of iron deposits in these patients, and could be responsible for the increased risk of developi ng diabetes mellitus.