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Diabetes Mellitus Is More Frequent in Patients with Hepatitis
C- Than in Hepatitis B-related Cirrhosis
Diabetes
mellitus (DM) is frequently observed in patients
with cirrhosis
due to hepatitis
C virus (HCV) infection. However, no studies
have focused on the clinical significance of glycemic control
in cirrhotic patients because of their short life expectancy
and poor hepatic function.
The
aim of this study was to evaluate the prognostic impact of
glycemic control in patients with hepatitis
B virus (HBV) and HCV-related
cirrhosis and DM.
A
total of 434 patients with HCV-related (HCV group, n = 88)
or HBV-related (HBV group, n = 346) cirrhosis were studied
retrospectively. The researchers determined the prevalence
of DM and treatment methods for hyperglycemia and status of glycemic control, and the patients'
outcome.
Results
The prevalence of DM was 43.2% (38/88) in the HCV group and
19.7% (68/346) in the HBV group.
Patients in the HCV
group were older with a female preponderance. DM was detected
before the diagnosis of cirrhosis or simultaneously in 92%
and 79% in the HCV and HBV groups, respectively.
Most
patients were treated with insulin or oral hypoglycaemic agents.
However, blood glucose
levels were maintained within the normal range in 34.2% of
the HCV group and in 23.5% of the HBV group.
Forty-six
patients died during the observation period in both groups.
Hepatic failure
was the most common cause of death,
and sepsis and variceal bleeding were more frequent in the
HCV group than in the HBV group.
Multivariate analysis
showed that Child-Pugh class was the most important factor
for survival in both groups.
In
the HCV group, the status of glycemic control was a significant
independent factor of survival (P = 0.018).
In
the HBV group, age and the development of spontaneous bacterial
peritonitis were significant.
Based
on these findings, the study authors conclude, “DM is more
frequent in patients with HCV-related cirrhosis than in patients
with HBV.”
Furthermore
they note, “Strict control of blood glucose levels could improve
survival
in HCV patients.”
Finally,
they write, “A precise assessment of the risks and benefits
of glycemic control is required to reduce the mortality
and morbidity of patients with cirrhosis and
DM.”
Department
of Internal Medicine, Division of Gastroenterology and Hepatology,
Gachon Medical School, Inchon, Korea.
10/28/05
Reference
S
Y Kwon and others. Prognostic significance of glycaemic
control in patients with HBV and HCV-related cirrhosis and
diabetes mellitus. Diabetes
Medicine 22(11):1530-1535.
November 2005.
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