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      Hepatitis c y diabetes mellitus tipo 2: un estudio prospectivo

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          Abstract

          Se ha establecido una relación epidemiológica entre hepatitis C crónica (HCV) Y Diabetes Mellitus tipo 2. El objetivo del presente estudio fue determinar de forma prospectiva la prevalencia de Diabetes Mellitus(DM) e intolerancia a la Glucosa en ayunas (IGA) en pacientes con hepatitis C crónica no tratados o naive, en comparación con la población general y con pacientes con enfermedades hepáticas de diferente etiología. Se incluyo una muestra de 13 pacientes que acudieron a la consulta de la Fundación Zuliana del Hígado desde Enero del año 2008 hasta Diciembre del año 2009 en el estudio. La prevalencia de DM e IGA fue de 38% comparado con 8% de la Población general (Centro Venezolano de información y estadística) y 25% del grupo control de 16 pacientes con enfermedades hepáticas de otras etiologías. De los 13 pacientes, cinco fueron Genotipo 1b, uno genotipo 1a y siete Genotipo 2a. De los pacientes con DM o IGA, dos fueron Genotipo 1b, uno 1a y dos 2a. De los cinco pacientes con DM o IGA cuatro tenían antecedente familiares de Diabetes. En conclusión, pacientes con HCV crónica tienen una mayor prevalencia de DM e IGA en comparación con la población general y con pacientes afectados por enfermedades hepáticas de otra etiología. El Genotipo no tuvo relación en este estudio con la DM o la IGA; los marcadores antropométricos de Obesidad estuvieron asociados en tres de los cinco pacientes lo cual sumado a la historia familiar de Diabetes siguiere una relación multifactorial en la patogénesis de la DM en los pacientes con HCV.

          Translated abstract

          An epidemiologic link between chronic Hepatitis C (HCV) and Type 2 Diabetes mellitus (DM) has been established. The objective of the present study was to prospectively determine the prevalence of Diabetes Mellitus (DM) and impaired fasting glucose (IFG) in patients with hepatitis C not treated or naive, in comparison with the general population and patients with other hepatic diseases. A sample of 13 patients who went to the outpatient clinic of the Zuliana Foundation of the Liver, from January of year 2008 to December of year 2009 was included in the study. The prevalence of DM and IGA was of 38% compared with 8% of the general Population (Center Venezuelan of information and statistic) and 25% of the group control of 16 patients with other hepatic diseases. Of 13 patients five were Genotype 1b, one genotype 1a and seven Genotype 2a. Of the patients with DM or IGA, two were Genotype 1b, one 1a and two 2a. Of the five patients with DM or IGA four had family history of Diabetes. In conclusion, patients with chronic HCV have a greater prevalence of DM and IGA in comparison with the general population and patients affected by different hepatics diseases. There was not relation in this study between the Genotype with the DM or the IGA; the anthropomorphic markers of Obesity were associated in three of the five patients, which added to the familiar history of Diabetes will follow a multifactorial relation in the pathogenesis of the DM in the patients with HCV.

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          Association of diabetes mellitus and chronic hepatitis C virus infection.

          While patients with liver disease are known to have a higher prevalence of glucose intolerance, preliminary studies suggest that hepatitis C virus (HCV) infection may be an additional risk factor for the development of diabetes mellitus. To further study the correlation of HCV infection and diabetes, we performed a retrospective analysis of 1,117 patients with chronic viral hepatitis and analyzed whether age, sex, race, hepatitis B virus (HBV) infection, HCV infection, and cirrhosis were independently associated with diabetes. In addition, a case-control study was conducted to determine the seroprevalence of HCV infection in a cohort of 594 diabetics and 377 clinic patients assessed for thyroid disease. In the former study after the exclusion of patients with conditions predisposing to hyperglycemia, diabetes was observed in 21% of HCV-infected patients compared with 12% of HBV-infected subjects (P =.0004). Multivariate analysis revealed that HCV infection (P =.02) and age (P =.01) were independent predictors of diabetes. In the diabetes cohort, 4.2% of patients were found to be infected with HCV compared with 1.6% of control patients (P =.02). HCV genotype 2a was observed in 29% of HCV-RNA-positive diabetic patients versus 3% of local HCV-infected controls (P <.005). In conclusion, the data suggest a relatively strong association between HCV infection and diabetes, because diabetics have an increased frequency of HCV infection, particularly with genotype 2a. Furthermore, it is possible that HCV infection may serve as an additional risk factor for the development of diabetes, beyond that attributable to chronic liver disease alone.
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            Prognostic significance of diabetes in patients with cirrhosis.

            Alterations in carbohydrate metabolism are frequently observed in cirrhosis, and approximately 15% to 30% of patients have overt diabetes. In a retrospective and prospective study in cirrhosis, we analyzed the prognostic significance of diabetes, which was defined as the presence of hyperglycemia and overt glycosuria that in most cases required dietary restrictions or active treatment. The clinical records of all patients with cirrhosis admitted to our department for the period 1980 to 1985 were reviewed in 1985 and 1986, and surviving patients were prospectively followed up until December 1991. Final status could be obtained in 354 (98 with diabetes) of 382 eligible patients; 110 were alive at the end of follow-up. Prognostic factors were identified by Kaplan-Meier analysis, followed by Cox's stepwise regression. The model identified, in sequence, albumin, ascites, age, encephalopathy, bilirubin, diabetes, and platelets as prognostic factors. The larger mortality rate in patients with diabetes was not due to complications of diabetes but to an increased risk of hepatocellular failure. Diabetes was no longer a risk factor as a covariate in a subgroup of 271 patients when varices were added but was again significant when patients who died of gastrointestinal bleeding were excluded. The presence of diabetes, clinically detectable and often requiring adequate treatment, is a risk factor for long-term survival in cirrhosis.
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              Prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C, alcohol, or cholestatic disease.

              The aims were to study: 1) the prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C, alcohol, or cholestatic liver disease, 2) viral and host immunogenetic factors that may predispose to diabetes, and 3) liver transplantation outcome in patients with or without diabetes. Fasting blood glucose values of patients who underwent liver transplantation because of hepatitis C-related cirrhosis (73 patients) were compared with those of patients with cirrhosis due to cholestatic (78 patients) or alcoholic liver disease (53 patients) and to a general population. Data on diabetes prevalence in a population without liver cirrhosis was based on the prevalence of diabetes in Olmsted County, Minnesota, residents. HLA was determined using serologic assays. Hepatitis C virus genotypes were determined with polymerase chain reaction amplification and direct sequencing. Hepatitis G RNA was detected with polymerase chain reaction. Liver transplantation outcome in patients with or without diabetes was determined with rejection, retransplantation, or death at 1 year after transplantation as end points. Of 64 patients with hepatitis C alone, 16 (25%) had diabetes before transplantation compared with 1 of 78 (1.3%) with cholestatic liver disease (p= 0.0001) and 10 of 53 (19%) with alcoholic liver disease (p=0.36). Nine patients had hepatitis C plus cholestatic liver disease; one of these (11%) had diabetes. The prevalence of diabetes in patients with cholestatic liver cirrhosis was not different from that of the general population. The frequency of hepatitis G virus coinfection, HLA-DR3, or HLA-DR4 in hepatitis C and diabetes was not different from that of hepatitis C alone. The distribution of hepatitis C virus genotype was similar in those with and those without diabetes. Diabetes was not associated with increased risk of rejection, retransplantation, or death at 1 year after transplantation, and had no impact on overall survival after transplantation. 1) The risk of diabetes is not increased in patients with liver cirrhosis due to cholestatic liver disease but is in patients with liver cirrhosis due to hepatitis C or alcoholic liver disease; 2) cofactors (age, sex, body mass index, hepatitis G virus coinfection, hepatitis C virus genotype, or HLA-DR3/DR4) did not explain the increased risk of diabetes in patients with hepatitis C; 3) diabetes before liver transplantation did not change the outcome at 1 year after transplantation or survival.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                gen
                Gen
                Gen
                Sociedad Venezolana de Gastroentereología (Caracas )
                0016-3503
                January 2011
                : 65
                : 1
                : 42-45
                Article
                S0016-35032011000100010
                27919f42-708c-4231-b5a7-a0cacd875f08

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0016-3503&lng=en

                Chronic Hepatitis C,Diabetes Mellitus type 2,Impaired fasting glucose,Hepatitis Crónica C,Diabetes Mellitas tipo 2,Intolerancia a la Glucosa en ayunas

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