Insulin resistance and insulin secretion in non-diabetic non-dirrhotic patients with HCV

الملخص EN

Background and Aims: Chronic HCV infection is highly prevalent in Egypt, and is commonly associated with diabetes.

We aimed at studying insulin resistance and secretion in HCV infected population prior to development of cirrhosis or diabetes to find out how HCV predisposes to diabetes.

Material and Methods: We studied 30 patients (aged 42 ±8 yr) with HCV +ve sera (by 3rd generation ELISA) who were diagnosed during blood donation.

We also studied 10 normal controls (aged 38±6.5 yr).

Those with clinical, biochemical or sonographic evidence of cirrhosis were excluded, as well as those who showed diabetic response to 75 gm oral glucose load.

The patients had transaminases that did not exceed 2.5 times ULN.

Insulin resistance was studied by the OGTT frorm which was calculated IIOMA-IR (FPIXFPG/22.5) and Matsuda - DeFronzo formula (ISI=10000/sq.root (FPI XFPG) X (OGTT-IX OGTT-G).

Early phase of insulin secretion was studied as the acute insulin response (AIR) to IV injection of 50 gm glucose, at 3 and 6 minutes.

Total insulin secretion to oral glucose was studied as the area under the curve (AUC) of insulin response to OGTT in 2 hours.

Results: HCV patients had FPG 80+16 mg/dl and 2 hours after oral glucose PG 109±27 mg/dl.

3/30 had IGT and 3 had IFG, while 24 had NGT.

6/30 had elevated transaminases (<2.5 ULN).

Mean ASTfor HCV group was 30±18 and ALT was 26+17IU/L.

They had mean serum albumin 4.13±0.37gm/dl, bilirubin 0.65±0.3 mg/dl and prothrombin time 11.5±0.5 seconds, confirming the absence of clinical cirrhosis.

10/30 patients had FH +ve for diabetes as well as 2/10 controls.

HOMA-IR was significantly higher in patients than controls (4.7±1.3 vs.

1.42±0.45, p<0.001) and in patients with +ve FH history for DM than those without (8.2 ±2.2 vs.

3.0±0.8, p<0.01).

Similarly, ISI was significantly lower in HCV patients than controls (3.6±1.6 vs.10.7±8.8, p<0.01).

AUC-I was higher in HCV patients than control, denoting hyperinsulinemia (143±70 juU/ml.hour vs.

98±54, p<0.05).

AIR did not differ significantly between HCV and control (7.1 ±2.9 vs.

6.3±2.9 juU/ml.hour, p>0.05) Conclusion: Non-diabetic non-cirrhotic HCV patients are insulin resistant.