Hepatitis C and Diabetes

NHANES III showed that among 9,841 patients older than 20, 8.4% had
diabetes and 2.1% had hepatitis C with an estimated 3.7 fold increase in the
risk of having or developing T2DM among patients infected with hep C;
additionally diabetes and IR were independent predictors of liver-related
mortality in HCV in the same study1
4X risk of HCC in patients w/diabetes and similar increased incidence of
diabetes in HCC patients2
Trial of 1084 adults, HCV-positive patients at high risk of developing diabetes
(based on BMI and age) were 11 times more likely to develop diabetes than
HCV-negative individuals3
In a meta analysis of 34 studies for a total of 300,000 patients, pooled
estimate of T2DM in HCV patients was an adjusted odds ratio of
approximately 1.68 (95% confidence interval [CI] 1.152.20), significant in
both prospective and retrospective meta-analyses4
20,486 veterans treated for HCV noted a reduced incidence of diabetes
(hazard ratio 0.76, 95% CI 0.700.82) in patients achieving SVR5
Retrospective cohort study of 10,259 patients showed increase in
cardiovascular mortality among HCV-positive blood donors (hazard ratio
2.21, 95% CI: 1.41, 3.46) and larger carotid intima-media thickness (IMT), an
index of early atherosclerosis, in HCV-positive patients when compared with
HCV negative controls6
Study of 173 patients showed association between HCV infection and
congestive heart failure 2.49 (1.045.96) but not ischemic heart disease and
stroke7

Take home point: Curing HCV may be associated with reduced incidence of
diabetes and possibly an improved cardiovascular risk profile.

Current standard therapy: Patients w/Metavir score 2, triple therapy with

peginterferon and ribavirin + boceprevir/telaprevir for 12 weeks, if no
response add 36 wks
New Tx: Three trials including 1952 patients showed Ledipasvirsofosbuvir
for 8 weeks was associated with a high rate (>95%) of sustained virologic

1 Williams I. Am J Med 1999;107:2S-9S

2 Adami HO et al. J Natl Cancer Inst 1996;88:1472-7 and Wideroff L et al. J Natl Cancer Inst

1997;89:1360-5
3 Mehta SH et al. Ann Intern Med 200;133(8)592-599
4 White DL et al. J Hepatol. 2008;49(5)831-844.
5 Hyder SM et al. Gastroentereology. 2013;144(5)S951
6 Guiltinan AM et al. Am J Epidemiol. 2008;167(6):743-750 and Targher G et al. J Hepatol. 2007;
46(6):1126-1132
7 Younossi ZM et al. Aliment Pharmacol Ther. 2013;37(6):647-652.

response among previously untreated patients with HCV genotype 1

infection without cirrhosis.8
Cost Benefit:
Lifetime cost of an individual infected with HCV in 2011 was estimated at
$64,490
Cost of a 12-week regimen of sofosbuvir alone is $84,000 and ledipasvir will
add to cost
Direct medical cost of diabetes over lifetime diagnosed at age 45-64 is
~$84,000-110,000
Cost of CHF per person per year is ~$4,000 so if diagnosed at 60 and live to
80, ~$80,000

8 Kowdley KV et al. NEJM. 2014;370:1879-1888.