Does Hepatitis C eradication lead to improved glucose metabolism, renal and cardiovascular outcomes in diabetic patients?
Li J, Gordon SC, Rupp LB, Zhang TL, Trudeau S, Holmberg SD, Moorman AC, Spradling PR, Teshale EH, Boscarino JA, Schmidt MA, Daida Y, and Lu M. Does Hepatitis C eradication lead to improved glucose metabolism, renal and cardiovascular outcomes in diabetic patients? Hepatology 2017; 66:525A.
Background and Aims: Emerging data shows that successful treatment may impact long‐term extra‐hepatic outcomes in hepatitis C (HCV) patients with type 2 diabetes mellitus (T2D). Previous analyses have excluded untreated HCV patients. We used data from the Chronic Hepatitis Cohort Study (CHeCS) to assess T2D‐related outcomes in patients under routine clinical care. Methods: We identified HCV patients with a diagnosis code for T2D and indications of ongoing use of diabetes medication as of 12/31/16. Outcomes included glycosylated hemoglobin (HbA1c), end‐stage renal disease (ESRD), acute coronary syndrome (ACS), and ischemic stroke at 5 years Treated patients were 1:1 matched with untreated patients. We adjusted for baseline differences using propensity scores. For HbA1c, we used a piecewise, linear spline, mixed effects model. Cumulative incidence of T2D‐related complications was estimated using the Fine‐ Gray model, with death as a competing risk. Results: 336 patients (168 untreated, 168 treated) were included with 5 years of follow‐up. 99 patients had SVR. HbA1c in SVR patients evolved in three phases: 1) 0‐9 months post‐index, HbA1c decreased significantly over time—7% per 90 days (p<0.0001); 2) 9‐33 months post‐index, HbA1c rose 2.2% per 90 days (p<0.0001); and 3) >33 months, HbA1c stabilized. The pattern remained after adjustment for BMI over time. SVR patients demonstrated decreased risk of ACS and ESRD compared to untreated patients (HR=0.44 and 0.28, P‐value=0.037 and 0.039 respectively). There was no significant difference between groups for stroke; however, we observed decreasing risk across treatment status and outcome. Conclusions: Successful HCV treatment significantly reduces incidence of T2D‐related outcomes compared to untreated patients. In SVR patients, HbA1c significantly improves shortly after treatment, but rebounds over time.