Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus

Abstract

Aim . To assess the effect of treating chronic hepatitis C virus (HCV) infection with direct acting antiviral drugs (DAAs) on glycemic control in patients with concomitant diabetes mellitus (DM). Methods . We performed a retrospective case-control study in a viral hepatitis ambulatory clinic in Shreveport, Louisiana, during the period 11/01/2014 to 12/31/2017. All the clinic patient ages 18 years and above with treatment-naïve/biopsy-proven chronic hepatitis C and DM (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"><mml:mtext>hemoglobin</mml:mtext><mml:mtext> </mml:mtext><mml:mtext>A</mml:mtext><mml:mn>1</mml:mn><mml:mtext>C</mml:mtext><mml:mtext> </mml:mtext><mml:mtext>level</mml:mtext><mml:mo>≥</mml:mo><mml:mn>6.5</mml:mn><mml:mi>%</mml:mi></mml:math>) who were eligible for treatment were included in the study. Of 118 such patients, 59 were treated with oral DAAs for 8-12 weeks with the goal of achieving a sustained virologic response (SVR). A control group of 59 patients did not receive treatment for their hepatitis C and was followed in the clinic. Patients in the control group did not receive treatment either due to insurance issues or refusal of hepatitis C treatment. Results . Fifty-five of the 59 patients treated with DAAs (93%) achieved a SVR. Six months after treatment completion, their <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"><mml:mtext>mean</mml:mtext><mml:mo>±</mml:mo><mml:mtext>SEM</mml:mtext></mml:math> HbA1C level had decreased by <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M3"><mml:mn>1.1</mml:mn><mml:mo>±</mml:mo><mml:mn>0.03</mml:mn><mml:mi>%</mml:mi></mml:math> (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M4"><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.0001</mml:mn></mml:math>). Four of the 59 patients treated with DAAs did not achieve a SVR. Their mean HbA1C 6 months after treatment completion had increased by <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M5"><mml:mn>0.8</mml:mn><mml:mo>±</mml:mo><mml:mn>0.2</mml:mn><mml:mi>%</mml:mi></mml:math>. Furthermore, there was no improvement in HbA1C levels over time in the untreated group (mean HbA1C increase, <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M6"><mml:mn>0.2</mml:mn><mml:mo>±</mml:mo><mml:mn>0.05</mml:mn><mml:mi>%</mml:mi></mml:math>; <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M7"><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>0.0001</mml:mn></mml:math> vs. the treatment group, which had a mean HbA1C decrease of <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M8"><mml:mn>0.9</mml:mn><mml:mo>±</mml:mo><mml:mn>0.2</mml:mn><mml:mi>%</mml:mi></mml:math>). Conclusion . This controlled study demonstrated that treatment of chronic hepatitis C with DAAs results in statistically significant and meaningful reductions in hemoglobin A1C levels in patients with coexisting diabetic mellitus if a SVR is achieved.