Successful hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes.

Sustained virological response to hepatitis C treatment decreases the incidence of complications associated with type 2 diabetes. 

Li J, et al. Aliment Pharmacol Ther. 2019 

Li J1, Gordon SC2, Rupp LB3, Zhang T1, Trudeau S1, Holmberg SD4, Moorman AC4, Spradling PR4, Teshale EH4, Boscarino JA5, Schmidt MA6, Daida YG7, Lu M1; CHeCS Investigators.

Version of Record online: 16 January 2019

 https://doi.org/10.1111/apt.15102

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The present analysis from a large and diverse cohort of patients with type 2 diabetes shows that successful HCV treatment reduced the risks of acute coronary syndrome, end‐stage renal disease, ischaemic stroke, and retinopathy by 39%‐66%; this effect was independent of patients’ baseline fibrosis status, and consistent in subgroup analyses restricted to patients with and without cirrhosis. Chronic HCV infection, independent of diabetic status, is known to confer an increased risk of extrahepatic complications; treatment status and outcome have been associated with improvement in some, but not all, of these conditions. The magnitude of risk reduction we observed within HCV patients with T2D supports the importance of antiviral therapy among diabetic patients to reduce risk of these extrahepatic outcomes.

Abstract

BACKGROUND:

The role of hepatitis C (HCV) eradication on the long-term complications of type 2 diabetes mellitus remains incompletely studied.

AIM: 

We investigated whether antiviral treatment impacted risk of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy among diabetic patients from the four US health systems comprising the Chronic Hepatitis Cohort Study (CHeCS).

METHODS: 

We included CHeCS HCV patients with diagnosis codes for type 2 diabetes who were on antidiabetic medications. Patients were followed until an outcome of interest, death, or last health system encounter. The effect of treatment on outcomes was estimated using the competing risk analysis (Fine-Gray subdistribution hazard ratio [sHR]), with death as a competing event.

RESULTS: 

Among 1395 HCV-infected patients with type 2 diabetes, 723 (52%) were treated with either interferon-based or direct-acting antivirals (DAAs); 539 (75% of treated) achieved sustained virological response (SVR). After propensity score adjustment to address treatment selection bias, patients with SVR demonstrated significantly decreased risk of acute coronary syndrome (sHR = 0.36; P < 0.001), end-stage renal disease (sHR = 0.46; P < 0.001), stroke (sHR = 0.34; P < 0.001), and retinopathy (sHR = 0.24; P < 0.001) compared to untreated patients. Results were consistent in subgroup analyses of DAA-treated patients and interferon-treated patients, an analysis of cirrhotic patients, as well as in sensitivity analyses considering cause-specific hazards, exclusion of patients with on-treatment retinopathy, and treatment status as a time-varying covariate.

CONCLUSION: 

Successful HCV treatment among patients with type 2 diabetes significantly reduces incidence of acute coronary syndrome, end-stage renal disease, ischaemic stroke, and retinopathy, regardless of cirrhosis. Our findings support the importance of HCV antiviral therapy among patients with type 2 diabetes to reduce the risk of these extrahepatic outcomes.

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© 2019 John Wiley & Sons Ltd.