Association of abnormal glucose tolerance with liver‐related disease and cardiovascular diseases in patients with chronic hepatitis C

• Published in: Hepatology research 2023-09, Vol.53 (9), p.806-814
• Main Authors: Konishi, Fumiaki, Miyake, Teruki, Watanabe, Takao, Tokumoto, Yoshio, Furukawa, Shinya, Matsuura, Bunzo, Yoshida, Osamu, Miyazaki, Masumi, Shiomi, Akihito, Kanzaki, Sayaka, Nakaguchi, Hironobu, Nakamura, Yoshiko, Imai, Yusuke, Koizumi, Mitsuhito, Yamamoto, Yasunori, Koizumi, Yohei, Hirooka, Masashi, Takeshita, Eiji, Kumagi, Teru, Ikeda, Yoshio, Abe, Masanori, Hiasa, Yoichi
• Format: Article
• Language: English
• Subjects: Ascites; cardiovascular disease; Cardiovascular diseases; Chromium; chronic hepatitis C; Cirrhosis; Diabetes mellitus; Fibrosis; Glucose; glucose intolerance; Glucose tolerance; Hepatic encephalopathy; Hepatitis C; Hepatocellular carcinoma; Intolerance; Liver cancer; Liver cirrhosis; Liver diseases; Multivariate analysis; prediabetes; Risk factors
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.13925

Aim Hepatitis C complicated by diabetes mellitus (DM) is considered a risk factor for the progression of fibrosis and development of hepatocellular carcinoma (HCC) and cardiovascular diseases. However, several studies may have lacked appropriate diagnosis of glucose intolerance. We aimed to examine the risk associated with abnormal glucose intolerance in the development of liver‐related diseases, including HCC and complications of liver cirrhosis, such as ascites, esophageal and gastric varices, and hepatic encephalopathy, and cardiovascular diseases in patients with hepatitis C accurately diagnosed with impaired glucose tolerance. Methods This longitudinal retrospective study included 365 patients with chronic hepatitis C admitted to Ehime University Hospital for anti‐hepatitis C therapy between September 1991 and January 2015. Patients were classified into normal glucose tolerance (NGT), prediabetes, and DM groups based on 75‐g oral glucose tolerance test results. Results Both univariate and multivariate (adjusted for potential confounders) analyses revealed a significantly higher risk of developing HCC and cardiovascular events in the DM group than in the NGT group. However, in multivariate analysis, liver‐related events, particularly liver cirrhosis complications, revealed no significant association. In addition, the prediabetes group had no significant risk of any outcome. Conclusions Patients with hepatitis C complicated by DM, compared with patients with hepatitis C with NGT or complicated with prediabetes, have a higher risk of HCC and cardiovascular disease events, but not liver‐related events, particularly in not developing liver cirrhosis complications. Therefore, appropriate follow‐up is required for patients with hepatitis C based on their glucose tolerance status. For diabetes mellitus, neither normal glucose tolerance nor prediabetes, is a significant risk for hepatocellular carcinoma and cardiovascular events in patients with hepatitis C. However, diabetes mellitus is not a risk for developing complications of liver cirrhosis. Therefore, appropriate follow‐up based on glucose tolerance is required for patients with hepatitis C.