Improvement in glycemic control of type 2 diabetes after successful treatment of hepatitis c virus

Abstract

OBJECTIVE Hepatitis C virus (HCV) infection is associatedwith diabetes andmayworsen glycemic control in patients with diabetes. We aimed to investigate whether eradication of HCV infection with direct-acting antiviral (DAA) agents is associated with improved glycemic control in patients with diabetes. RESEARCH DESIGN AND METHODS We identified 2,435 patients with diabetes who underwent interferon-free and ribavirin-free DAA-based antiviral treatment for HCV in the national Veterans Affairs health care system. Changes in average hemoglobin A1c (HbA1c) level and use of antidiabetic medications 1 year before and after antiviral treatment were compared between patients who achieved sustained virologic response (SVR) and thosewho did not. RESULTS Among patients with elevated baseline HbA1c, the drop in HbA1c associated with antiviral treatmentwas greater in thosewho achieved SVR (0.98%) than in thosewho sustained treatment failure (0.65%) (adjustedmean difference 0.34, P = 0.02).Use of antidiabeticmedications decreasedmore in patients who achieved SVR than in those who sustained treatment failure, especially for the use of insulin, which dropped significantly from 41.3% to 38% in patients achieving SVR compared with a slight increase from 49.8% to 51% in those who sustained treatment failure. CONCLUSIONS DAA-based eradication of HCV is associated with improved glycemic control in patients with diabetes as evidenced by decreased mean HbA1c and decreased insulin use. These endocrine benefits of SVR provide additional justification for considering antiviral treatment in all patients with diabetes.