Insulin resistance tied to hepatitis C infection

By Michelle Rizzo

NEW YORK (Reuters Health) - Insulin resistance, a "prediabetic" abnormality of blood sugar, is a specific feature of chronic hepatitis C virus (HCV) infection, independent of the severity of HCV or the presence of other metabolic factors, French investigators report.

HCV infection is now recognized as a system-wide disease, Dr. Rami Moucari, of Universite Denis Diderot-Paris, and colleagues note in a report in the journal Gastroenterology. Some previous studies have linked HCV infection to an increased risk of insulin resistance or full-blown diabetes.

Insulin is the body's key blood sugar-regulating hormone. Normally, insulin is secreted to clear glucose (sugar) from the blood and deposit into cells to use as fuel. Insulin resistance occurs when cells become desensitized to insulin.

In their study, Moucari's team found that 150 (32.4 percent) of 462 chronic HCV patients who did not have diabetes were insulin resistant. In this group, insulin resistance was associated with the metabolic syndrome (a cluster of heart disease and diabetes risk factors), as well as HCV genotypes 1 and 4, significant liver scarring or "fibrosis," severe fatty liver disease, and being older than age 40.

Among 145 chronically HCV infected patients without metabolic syndrome or significant fibrosis, insulin resistance was diagnosed in 22 (15 percent). Insulin resistance in this population was also associated with infection with HCV genotypes 1 and 4, high blood levels of HCV, and moderate-to-severe liver inflammation.

"Insulin resistance should be assessed in the routine management of patients with chronic hepatitis C," Moucari noted in an interview with Reuters Health.

SOURCE: Gastroenterology, February 2008.