Effect of Direct Acting Antiviral Drugs on HbA1c in Type 2 Diabetic Patients Infected with Chronic Hepatitis C Infection
DOI:
https://doi.org/10.70749/ijbr.v3i7.2895Keywords:
Hepatitis C, direct acting antiviral therapy, HbA1C, diabetes mellitusAbstract
Background: There is emerging evidence that direct acting antiviral therapy in HCV patients affect insulin resistance. This study is being conducted to study the impact of direct acting antiviral drugs on glycaemic control in terms of pre- and post-treatment mean HbA1C among hepatitis C virus positive diabetic patients, treated at tertiary care hospital of northern Pakistan. Material and Methods: This Quasi-Experimental Model study was conducted between 6 Feb 2025 to 31st May 2025 at the Hepatology Department, Fauji Foundation Hospital, Islamabad. A total of 60 male and female diabetic patients with confirmed HCV positive and planned for DAA therapy and having age between 18-75 years were enrolled using the non-probability consecutive sampling after getting aw written informed consent. Baseline HbA1c was determined and patients were followed up monthly. After four weeks of the treatment, the HbA1C and values were repeated. Data was analyzed using SPSS software version 25. Study confounders like were controlled by the stratification. Post stratification, paired t-test was used to see the statically significant difference (p-value ≤ 0.05). Results: The mean age was 51.42 ± 13.35 years, with a predominance of female participants (70%). Paired sample analysis showed that the mean pre-treatment HbA1c was 8.90 ± 2.19%, which significantly decreased to 7.42 ± 1.41% following completion of DAA therapy. The mean reduction in HbA1c was 1.48% (95% CI: 1.20–1.76). This improvement was statistically significant (paired t-test: t = 10.60, df = 59, p < 0.001). A strong positive correlation was observed between pre- and post-treatment HbA1c values (r = 0.91, p < 0.001). Conclusion: The current research proves that a direct-acting antiviral (DAA) treatment of hepatitis C virus (HCV) infection is linked to a meaningful increase in glycaemic control in patients with type 2 diabetes mellitus (T2DM), indicating that the glycated haemoglobin (HbA1c) level declined consistently within all the investigated groups. HCV treatment does not only reduce hepatic complications but also enhances the management of diabetes, which may reduce long-term vascular complications and healthcare expenses, as well.
Downloads
References
https://doi.org/10.3390/v16071115
2. Mansoor M, de Glanville WA, Alam R, Aslam K, Ahmed M, Isaakidis P, et al. Prevalence and risk factors for hepatitis C virus infection in an informal settlement in Karachi, Pakistan. PLOS Glob Public Health. 2023;3(9):e0002076.
https://doi.org/10.1371/journal.pgph.0002076
3. Syed SH, Umar M, Akhter TS, Hussain T, Salamat A, Ahmad SI, et al. An Update on National Consensus Practice Guidelines for the Treatment of Hepatitis C & Literature Review in Epidemiology of Hepatitis C in Pakistan - 2022. JRMC. 2024;1(1):1-4.
https://doi.org/10.37939/jrmc.v1i1.2533
4. Ndako JA, Owolabi AO, Olisa JA, Akinwumi JA, Dojumo VT, Olatinsu O, et al. Studies on the prevalence of Hepatitis C virus infection in diabetic patients attending a tertiary health-care facility South-west Nigeria. BMC Infect Dis. 2020;20(1):664-7.
https://doi.org/10.1186/s12879-020-05388-7
5. Zeng H, Li L, Hou Z, Zhang Y, Tang Z, Liu S. Direct-acting Antiviral in the Treatment of Chronic Hepatitis C: Bonuses and Challenges. Int J Med Sci. 2020;17(7):892-902.
https://doi.org/10.7150/ijms.43079
6. Wong AH, Sie J, Chen A, Gunawan B, Chung J, Rashid N. Glycemic Control after Initiating Direct-Acting Antiviral Agents in Patients with Hepatitis C Virus and Type 2 Diabetes Mellitus Using the United States Integrated Healthcare System. J Res Pharm Pract. 2020;9(1):16-23.
https://doi.org/10.4103/jrpp.jrpp_19_110
7. Mada PK, Malus ME, Parvathaneni A, Chen B, Castano G, Adley S, Moore M, Hieda M, Alam MJ, Feldman M, King JW. Impact of Treatment with Direct Acting Antiviral Drugs on Glycemic Control in Patients with Hepatitis C and Diabetes Mellitus. Int J Hepatol. 2020; 2020:6438753-7.
https://doi.org/10.1155/2020/6438753
8. Hagag RY, Selim AF, Darrag OM, Zied H, Aboelnasr MS. Does Hepatitis C Virus Treatment by Directly Acting Antivirals Obligate Shifting Patients with Type 2 Diabetes from Oral Hypoglycemic Drugs to Insulin Therapy? Diabetes Metab Syndr Obes. 2022; 15:1261-8.
https://doi.org/10.2147/dmso.s354023
9. Lim AG, Scott N, Walker JG, Hamid S, Hellard M, Vickerman P. Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis. PLoS Med. 2021;18:e1003818-23.
https://doi.org/10.1371/journal.pmed.1003818
10. Weidner P, Boettche D, Zimmerer T, Burgermeister E, Teufel A, Ebert MPA, Antoni C. Impact of direct acting antiviral (DAA) treatment on glucose metabolism and reduction of pre-diabetes in patients with chronic hepatitis C. J Gastrointestin Liver Dis. 2018 Sep;27(3):281-289.
https://doi.org/10.15403/jgld.2014.1121.273.daa.
11. American Diabetes Association Professional Practice Committee. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022 Jan 1;45(Suppl 1):S17-S38.
https://doi.org/10.2337/dc22-S002.
12. Stine JG, Wynter JA, Niccum B, Kelly V, Caldwell SH, Shah NL. Effect of Treatment with Direct Acting Antiviral on Glycemic Control in Patients with Diabetes Mellitus and Chronic Hepatitis C. Ann Hepatol. 2017 Mar-Apr;16(2):215-220.
https://doi.org/10.5604/16652681.
13. Chen B, Iqbal U, Desai SK, Gries J, Verheyen E, Xie M, et al. The role of treatment of hepatitis C with direct-acting antiviral agents on glycaemic control in diabetic patients: An updated systematic review and meta-analysis. J Viral Hepat. 2024 Oct;31(10):633-642.
https://doi.org/10.1111/jvh.13984.
14. Adinolfi LE, Nevola R, Guerrera B, D'Alterio G, Marrone A, Giordano M, et al. Hepatitis C virus clearance by direct-acting antiviral treatments and impact on insulin resistance in chronic hepatitis C patients. J Gastroenterol Hepatol. 2018 Jul;33(7):1379-1382.
https://doi.org/10.1111/jgh.14067.
15. Pavone P, Tieghi T, d'Ettorre G, Lichtner M, Marocco R, Mezzaroma I, Passavanti G, Vittozzi P, Mastroianni CM, Vullo V. Rapid decline of fasting glucose in HCV diabetic patients treated with direct-acting antiviral agents. Clin Microbiol Infect. 2016 May;22(5):462.e1-3.
https://doi.org/10.1016/j.cmi.2015.12.030.
16. Hum J, Jou JH, Green PK, Berry K, Lundblad J, Hettinger BD, et al. Improvement in Glycemic Control of Type 2 Diabetes After Successful Treatment of Hepatitis C Virus. Diabetes Care. 2017 Sep;40(9):1173-1180.
https://doi.org/10.2337/dc17-0485.
17. Dawood AA, Nooh MZ, Elgamal AA. Factors Associated with Improved Glycemic Control by Direct-Acting Antiviral Agent Treatment in Egyptian Type 2 Diabetes Mellitus Patients with Chronic Hepatitis C Genotype 4. Diabetes Metab J. 2017 Aug;41(4):316-321. PMID: 28868829; PMCID: PMC5583409.
https://doi.org/10.4093/dmj.2017.41.4.316.
18. Marzaban RN, AlMekhzangy HI, ElAkel W, ElBaz TM, ElShazly YM, ElSaeed K, et al. Diabetic patients with chronic hepatitis C virus response compared to non diabetics when treated with directly acting antiviral therapy. Arab J Gastroenterol. 2024 May;25(2):118-124.
https://doi.org/10.1016/j.ajg.2023.12.006.
19. Rehman GU, Ali M, Shah F, Iqbal A, Ahmad A, Hayat Z, et al. Prevalence of Diabetes Type 2 in Hepatitis C Infected Patients in Kpk, Pakistan. Biomed Res Int. 2017; 2017:2416281.
https://doi.org/10.1155/2017/2416281.
20. Andres J, Barros M, Arutunian M, Zhao H. Treatment of Hepatitis C Virus and Long-Term Effect on Glycemic Control. J Manag Care Spec Pharm. 2020 Jun;26(6):775-781. PMID: 32463777; PMCID: PMC10390901.
https://doi.org/10.18553/jmcp.2020.26.6.775.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
