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INSULIN RESISTANCE REDUCTION AFTER SUSTAINED VIROLOGICAL RESPONSE WITH DIRECT ACTING ANTIVIRAL:NOT EVERY POPULATION IMPROVES.
- Source :
-
Arquivos de gastroenterologia [Arq Gastroenterol] 2018 Jul-Sep; Vol. 55 (3), pp. 274-278. - Publication Year :
- 2018
-
Abstract
- Background: Hepatitis C virus (HCV) infection is a serious public health problem, that affects approximately 170 million people worldwide. Chronic HCV infection is associated with hepatic insulin resistance and an increased risk of diabetes HCV-infected patients has been well documented.<br />Objective: To assess the homeostasis model assessment of insulin resistance (HOMA-IR) index in patients treated with direct acting antiviral (DAAs) medication in the sustained virological response (SVR), categorized by the presence or absence of cirrhosis.<br />Methods: A prospective study was conducted. Data were collected at the beginning of treatment (t-base) and in the twelfth week after the completion of treatment (t-SVR12). The inclusion criteria were presence of: HCV infection (RNA-HCV positive), age ≥18 years, completion of DAAs' therapy, and presence of diabetes with use of oral hypoglycemic agents. All samples were collected during the study period. The exclusion criteria were: presence of HBV/HIV co-infection, hepatocellular carcinoma at baseline, diabetic patients taking insulin and transplanted patients (liver/kidney). Fibrosis was assessed by hepatic elastography or biopsy (METAVIR). Cirrhosis was determined by clinical results or imaging. HOMA-IR was calculated as fasting insulin (μU/mL) × fasting glucose (mmol/L)/22.5) The patients were divided into two groups: the general study population (all patients, including the diabetic patients) and the special population (patients with normal values of HOMA-IR, which is >2.5, and without diabetes). The delta HOMA-IR value was calculated as: HOMA-IR at t-base - HOMA-IR at t-SVR12. For the descriptive statistical analysis, the paired t-test and generalized linear model assuming the log binding function were performed. A P value of < 0.05 was considered significant.<br />Results: We included 150 patients, and 75 were cirrhotic. The mean age was 55.3±9.97 and body mass index was 27.4±5.18. Twenty-two (14.67%) were diabetic patients using oral hypoglycemic agents, and 17 (11%) were cirrhotic. In the general study population, the mean glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. Delta HOMA-IR was negative at t-SVR12, but there was no significant difference. Excluding diabetic patients and those with normal HOMA-IR values (<2.5), mean glucose, insulin and HOMA-IR decreased at t-SVR12. Delta HOMA-IR decreased significantly at t-SVR12 (P: 0.02).<br />Conclusion: In the general population, glucose and HOMA-IR values increased at t-SVR12, but insulin decreased. In the special population, glucose, insulin, HOMA-IR and Delta HOMA-IR decreased at t-SVR12.
- Subjects :
- Aged
Blood Glucose metabolism
Body Mass Index
Diabetes Mellitus etiology
Fasting blood
Female
Hepacivirus pathogenicity
Hepatitis C, Chronic complications
Humans
Liver Cirrhosis metabolism
Liver Cirrhosis virology
Male
Middle Aged
Prospective Studies
Reference Values
Reproducibility of Results
Treatment Outcome
Antiviral Agents metabolism
Antiviral Agents therapeutic use
Blood Glucose analysis
Hepatitis C, Chronic drug therapy
Hepatitis C, Chronic metabolism
Insulin blood
Insulin Resistance physiology
Subjects
Details
- Language :
- English
- ISSN :
- 1678-4219
- Volume :
- 55
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Arquivos de gastroenterologia
- Publication Type :
- Academic Journal
- Accession number :
- 30540091
- Full Text :
- https://doi.org/10.1590/S0004-2803.201800000-69