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  37th Annual Meeting of the European Association for the Study of the Liver
Madrid, Spain, April, 2002
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Ch. Drakoulis, M. Minadaki, L. Karasavidou, M. Panidou, Ch. Liarou, Ch. Samaras, K. Stagia, D. Katsadoros Hepatology Department, 2nd Pathology Clinic, General Hospital of Nikea, Piraeus, Greece
Aim: To examine the frequency of Type II diabetes in patients with chronic hepatitis B (CHB) or C (CHC).
Materials & Methods: 850 patients attending our clinic were examined. 98 were found with CHB (positive for HbsAg, anti-HBe, anti-HBc by ELISA and HBV-DNA by PCR) and 117 with CHC (positive for anti-HCV by 3rd generation ELISA). Patients were classified by gender, age and blood glucose levels.
Results: For the CHB patients, 31 males (57.4%) and 27 females (61.3%) had blood glucose < 110 mg/dl, 11 males (20.4%) and 7 females (15.9%) had blood glucose 110-126 mg/dl, and 12 males (22.2%) and 10 females (22.8%) had blood glucose > 126 mg/dl. For the CHC patients, 48 males (68.6%) and 34 females (72.4%) had blood glucose < 110 mg/dl, 9 males (12.8%) and 4 females (8.5%) had blood glucose 110-126 mg/dl, and 13 males (18.6%) and 9 females (12.9%) had blood glucose > 126 mg/dl.
Conclusions: In CHB patients, abnormal fasting glucose levels were observed in both males and females with similar frequency (mean 18%), mostly at ages 41-60 years. In CHC patients, abnormal fasting glucose levels were observed more frequently in males (12.8%) than females (8.5%), again mostly at ages 41-60 years. The overall frequency of Type II diabetes in both CHB and CHC patients is greater than that of the general population. Our results show a slightly higher incidence of diabetes mellitus in CHB patients, although it is not statistically significant.
Emanuel Manesis 1 , Anastasia Mavrogiannaki 1 , Elias Siakavellas 1 , Basil Karamanos 1, Stephanos Hadziyannis 2 1 Academic Department of Medicine, Hippokration General Hospital, Athens; 2 Henry Dynan Hospital, Athens, Greece
Diabetes is frequent among patients with chronic hepatitis C (CHC), but its pathogenesis is lacking.
Methods: We prospectively evaluated 100 consecutive patients with chronic viral hepatitis (57 CHC, 43 HBeAg-negative chronic hepatitis B [CHBeoooo ]) admitted for liver biopsy and compared them to 100 healthy controls, matched for age, sex and body mass index. Controls were randomly selected from a large database of a recent field study of diabetes prevalence performed by us.
Results: Known diabetes was not significantly different among CHC, CHBeoooo or controls (12.5%, 4.7% and 10% respectively; P = 0.424), but abnormal glucose tolerance (glucose intolerance or diabetes discovered by OGTT) was significantly higher in CHC than in controls (40.4% vs 14%, respectively; P < 0.001; OR 4.2, 95% CI 1.9-9.0) and not different between CHBeoooo and controls (14% vs 14%). By logistic regression analysis, significant predictors of abnormal OGTT in patients with chronic viral hepatitis were, HCV infection (RH 5.1, 95% CI 1.4-19.3; P = 0.016), serum ALT (RH 2.3, 95% CI 1.3-5.1; P = 0.007) and IgG levels (RH 12.4, 95% CI 1.8-84.9; P = 0.010).
Conclusions: Prevalence of glucose intolerance and new diabetes discovered by OGTT is 4.2 times higher in CHC but not different in CHBe patients compared to general population. Continuous hepatic necroinflammation and chronic immunological stimulation underlie and possibly are pathogenetically related to increased prevalence of diabetes in CHC.
Antonio Garrido 1 ,F.J.Guerrero 2 ,J.A.Lepe 3 ,S.Palomo 2 , A. Grilo 4 1 Department of Gastrointestinal Medicine, H. Riotinto (Huelva); 2 Department of Internal Medicine, H. Riotinto (Huelva); 3 Microbiology Unit, H. Riotinto (Huelva); 4 Department of Internal Medicine, H. Valme, Sevilla, Spain
Objectives: To carry out a prospective study of baseline insulinemia in non-diabetic cirrhotic patients infected with HCV, comparing their values with those of a group of non-HCV non-diabetic cirrhotic patients. To research the factors involved in both groups in the increase of peripheral resistance to insulin.
Material: A trial including 32 HCV cirrhotic diabetic patients (Group I) and 41 non-diabetic cirrhotic patients of other aetiologies (Group II) was carried out. Baseline insulinemia as well as insulin resistance factors like age, anthropometric indices, stage of cirrhosis and iron plasma levels were compared.
Results: The average baseline insulinemia values in group I was 21.5 mU/ml (18.6-24.4), vs 14 mU/ml (10-18) in group II (p < 0.001), and the percentage of hyperinsulinemia was 87.5% (72.5- 95.9) vs 56% (40.8-70.6), respectively (p < 0.01). No differences were observed in either group when comparing age, weight, height, body mass index and Child-Pugh staging score. Whereas serum ferritin levels in Group I patients were higher than those in Group II [123.3 (12.4-289.3) vs 65.5 (2.4-306) ng/ml, p < 0.05]. Multivariate logistic regression study demonstrated that insulinemia values (OR = 1.21; CI 95% 1.09-1.34, p < 0.001) and ferritin levels (OR = 1.21; CI 95% 1.02-1.052.69, p < 0.04) were independent factors associated to HCV.
Conclusions: HCV-positive non-diabetic cirrhotic patients have higher baseline insulinemia levels, as well as a greater prevalence of hyperinsulinemia than cirrhotics due to other aetiologies. This could be explained by an increase of peripheral insulin resistance, mediated by the increase of iron deposits in these patients, and may be responsible for the increased risk of developing diabetes mellitus.