A Study of the Association between Diabetes Mellitus and Chronic Hepatitis B Virus Infection / Un Estudio de la Asociación entre la Diabetes Mellitus y la Infección Crónica por el Virus de la Hepatitis B

ABSTRACT Background: Hepatitis B virus (HBV) infection and diabetes mellitus are major health problems associated with significant morbidity and mortality. The published literature suggests an association of diabetes mellitus with liver disease. However, the role of HBV infection in diabetes aetiology is still controversial. The present study was conducted to explore the veracity of this enigmatic association among Pakistani subjects. Methodology: The blood samples and clinical information were collected from chronic HBV-positive patients Group 1 (n = 120), and their age and gender were matched with those of the healthy control subjects Group 2 (n = 120). Hepatitis B virus-positive patients were also subdivided into two groups; (Group 1a and Group 1b) with and without liver cirrhosis for evaluation of the prevalence of diabetes. Results: The study revealed that there were statistically significant differences in the biochemical parameters in the HBV-positive and control groups. There was no correlation between diabetes and HBV with the prevalence of diabetes mellitus being similar in subjects with and without HBsAg (11.7% in the positive group and 10% in the controls). Since there were a relatively large number (32.5%) of HBV-positive patients with liver cirrhosis, a comparison of biochemical parameters was also carried out to evaluate the extent of the liver damage and its association with diabetes. During the comparison of HBV patients with and without cirrhosis for the prevalence of diabetes, no aetiologic association was found with diabetes. Conclusion: Study revealed that there was no correlation between HBV infection and diaabetes despite the significantly different biochemical parameters in the HBV-infected group and control subjects.

RESUMEN Antecedentes: La infección por el virus de la hepatitis B (VHB) y la diabetes mellitus son problemas de salud importantes asociados con morbilidad y mortalidad significativas. La literatura publicada sugiere una asociación de la diabetes mellitus con las enfermedades hepáticas. Sin embargo, el papel de la infección por VHB en la etiología de diabetes sigue siendo contro-versial. El presente estudio fue conducido con el propósito de explorar la veracidad de esta enigmática asociación entre sujetos paquistaníes. Metodología: Se recogieron muestras de sangre e información clínica de pacientes crónicos VHB positivos Grupo 1 (n = 120), y su edad y género fueron comparados con los de los sujetos sanos del control Grupo 2 (n = 120). Los pacientes positivos al virus de la hepatitis B también se subdividieron en dos grupos, a saber, (Grupo 1a y Grupo 1b) con y sin cirrosis hepática en relación con la prevalencia de la diabetes. Resultados: El estudio reveló que hubo diferencias significativas en estos dos grupos en los parámetros bioquímicos entre el grupo de control y el grupo VHB positivo. En estos dos grupos no hubo correlación entre la diabetes y el VHB. Puesto que hubo un número relativamente grande (32.5%) de pacientes VHB positivos con cirrosis hepática, se realizó también una comparación de los parámetros bioquímicos a fin de comprender el grado del daño hepático y su asociación con la diabetes. Durante la comparación de los pacientes con VHB con y sin cirrosis en relación con la prevalencia de diabetes, no se halló asociación etiológica con la diabetes. Conclusión: Este estudio reveló que no hubo correlación entre la infección por VHB y la diabetes, a pesar de los parámetros bioquímicos significativamente diferentes entre el grupo infectado por el VHB y los sujetos del control.

Hepatitis C virus genotype distribution in Egyptian diabetic patients: a preliminary study

There is controversy regarding whether a specific hepatitis C virus [HCV] genotype is associated with diabetes mellitus. This study aimed to investigate HCV genotype distribution in diabetics and its relation to some clinical and laboratory variables in HCV-positive diabetic versus non-diabetic Egyptians in East Delta. The study included 100 HCV-positive patients of which 66 were diabetic in addition to 35 healthy adults as a control group. Clinical assessment, laboratory measurements of plasma glucose, insulin, C-peptide, C-reactive protein [CRP], tumour necrosis Factor-alpha [TNF-alpha] and liver functions [alanine aminotransferase [ALT], aspartate aminotransferase [AST] and gamma-glutamyltransferase [GGT]] as well as HCV genotype determination were done, and AST/platelet ratio index [APRI] and Homoeostasis Model of Assessment-Insulin Resistance [HOMA-IR] were calculated. The main results were the presence of HCV genotype 3, in 31.8% of the diabetic group and in 26.5% of the non-diabetic group, while the remainder of cases had genotype 4, the predominant genotype in Egypt. This is the first report of the presence of HCV genotype 3 in about 30% of an Egyptian cohort. However, there was no significant difference in genotype distribution between both groups. Further, there were significantly higher values of HOMA-IR, insulin and C-peptide in HCV-positive groups in comparison to the control group, while TNF-alpha was significantly higher in the HCV-positive diabetic group. However, there were no significant differences between both genotypes regarding these parameters. Although this study reveals for the first time the presence of HCV genotype 3 in a significant percentage of a group of Egyptian patients, where the majority were diabetic, the association between diabetes and certain HCV genotypes could not be confirmed on the basis of our findings. Hence, taking into consideration the impact of such a finding on the treatment decisions of those patients, further studies are warranted to explore these findings to a greater extent

Prevalence of oral hairy leukoplakia and epithelial infection by Epstein-Barr virus in pregnant women and diabetes mellitus patients: cytopathologic and molecular study

Oral hairy leukoplakia (OHL) is generally reported in patients with severe immunosuppression, except for a few cases in individuals with moderate degree of immunodeficiency. It is a white lesion that appears mainly in the lateral border of the tongue, caused by Epstein-Barr virus (EBV). The nuclear changes caused by EBV (Cowdry A inclusion, ground glass and nuclear beading), observed in cytopathology, are specific and enough for the definitive diagnosis of OHL, independent of the identification of the virus. Here we investigated the prevalence of OHL and the presence of EBV-DNA in the lateral borders of the tongue from 90 pregnant women, 90 diabetes mellitus (DM) patients, 30 healthy individuals (negative group) and 30 HIV+ with OHL (positive group). Smears were analyzed by cytopathology and polymerase chain reaction (PCR). A case of subclinical OHL and candidiasis was identificated in a DM patient by cytopathologic analysis. PCR results demonstrated EBV-DNA in 65 percent of the pregnant women, in 35 percent of DM patients, and in 20 percent of the healthy individuals. We concluded that DM patients can develop OHL with a low prevalence. Furthermore, the prevalence of the EBV in lateral border of the tongue is larger in pregnant women than in healthy individuals.

Frequency of hepatitis C infection in diabetic patients

Diabetic patients are at an increased risk of acquiring Hepatitis C Virus [HCV] infection owing to the nature of the disease and its inherent complications or frequent parental exposure. On the other hand HCV infection may itself contribute to the development of Diabetes Mellitus. The epidemiological evidence of this association has not been studied in Pakistan at a population level and its exact biological mechanisms are not obvious. Objective of this study was to study the frequency of HCV infection among adult diabetic patients attending the Hospital the study comprised of 100 Diabetic patients visiting the outpatient clinics or admitted in the medical wards of a Teaching Hospital, in Peshawar. Diabetes was confirmed according to the new diagnostic criteria based on 2 fasting or 2 random plasma glucose levels of more than 126 milligram per deciliter [mg/dL] and 200 mg/dL respectively. The presence of HCV infection was confirmed by Enzyme Linked Immuno-Sorbent Assay [ELISA] method. A concise history of the patient, examination and laboratory findings were recorded on a Performa. Out of the hundred diabetics 36% were found to be anti HCV positive and all of them had type II diabetes. There was no gender difference in the seropositive cases. Serum Glutamic-Pyruvic Transaminase [SGPT] level was raised in 75% of the positive cases as compared to the 25% of the seronegative patients. The seropositive cases had a comparatively higher blood sugar level. HCV infection occurs more often in type II diabetic and further investigations should be done in diabetic patients with raised SGPT for the presence of chronic HCV infection

[Prevalence of hepatitis C among diabetes mellitus patients in Zahedan]

Several clinical studies have recently claimed that HCV infection could trigger the onset of diabetes mellitus [DM]. In order to determine the prevalence of hepatitis C virus [HCV] among patients with type 1, 2 diabetes mellitus [DM] and investigate the influence of several epidemiological factors on HCV infection, we conducted this study. In this case-control study we evaluated 505 diabetic patients [135 male, 370 female with the mean age of 54.5 years] who had referred to Diabetic clinic in Boo-Ali hospital [a teaching hospital in south east of Iran] in 2004. Serologic testing for anti- HCV was done using a third-generation commercial Enzyme-Linked Immunosorbent Assay [ELISA] and Real-time-PCR [HCV RNA] in order to confirm the anti-HCV positive samples. Diabetic patients [were divided in two groups according to their HCV antibody status and were analyzed for the following variables: age, sex, type of diabetes, duration of disease, mode of therapy, late diabetic complication, previous blood transfusions, intravenous drug addiction, hospital admissions and major surgical procedures. Then results were compared with the findings from blood donors. HCV infection was detected in one patient who had history of hospitalization and blood transfusion. However, a higher prevalence of HCV infection was not observed in diabetic patients in comparison with blood donors [P=0.46]. There was no correlation between HCV and diabetic type, duration, age, sex [P>0.05]. Upon the results of our study, we conclude that HCV infection is not a trigger factor for DM; therefore it should not be listed among the various extrahepatic manifestations of this viral infection. Although, further studies, possibly multicentre, are needed to estimate prevalence of HCV in diabetic patients

Seroprevalence of herpes simplex and Varicella zoster virus among diabetic and non-diabetic patients with acute peripheral facial palsy

The aim was to study the prevalence of herpes simplex virus [HSV] and varicella zoster virus [VZV] seropositive patients among diabetic patients with acute peripheral facial paralysis [APFP] as compared to non-diabetics with APFP and a healthy control group. Participants consisted of 40 diabetic patients and 40 non-diabetic patients with APFP from Hai Al-Jamea Hospital, Jeddah, Kingdom of Saudi Arabia studied over a period from July 2000 to December 2001. In addition, 20 age and sex matched healthy volunteers were included as a control group. Paired sera were obtained from all participants within the first 4 days of the illness [acute phase] and 2-3 weeks later [convalescent phase]. Paired sera were also obtained from the control group within an equivalent period. Detection of immunoglobulin [Ig] M and IgG class antibodies to HSV and VZV in these sera was carried out using enzyme-linked immunosorbent assays kits. The demonstration of IgM antibodies, 2-fold elevations of IgG antibodies or both was considered positive evidence for virus infection. The present study has shown that there was no statistically significant difference in the prevalence of HSV-seropositive patients in the diabetic and non-diabetic patients with Bell's palsy; however, it was significantly higher in both groups than in the healthy control group. There were no statistically significant differences in the prevalence of VZV-seropositive patients among the 3 groups. The significantly high prevalence of HSV-seropositive patients among the diabetic as well as the non-diabetic patients with Bell's palsy suggests an equally important role of HSV infection in the pathogenesis of Bell's palsy in the diabetic as in the non-diabetic patients

Prevalence and Clinical Significance of Diabetes Mellitus in Patients with Liver Cirrhosis / 대한간학회지

BACKGROUND/AIMS: Impaired glucose tolerance and overt diabetes mellitus (DM) frequently occurs in patients with chronic liver disease. Hyperinsulinaemia and peripheral insulin resistance contribute to the development of DM in these patients. The clinical relevance, however, of DM to their clinical course was not determined. We investigated the prevalence of DM in patients with liver cirrhosis and their clinical characteristics and prognosis. METHODS: A total of 606 consecutive cirrhotic patients were enrolled for 5 years. We reviewed all laboratory findings, clinical courses, and mortality, retrospectively. The cirrhotic patients were divided into two groups according to the presence of DM, and their clinical characteristics and mortality were compared. DM was diagnosed in accordance with National Diabetes Data Group criteria. RESULTS: Among the total of 606 cirrhotic patients (M:F, 482:124), 346 (57.1%) had HBV related disease and 60 (10%) had HCV related disease. Forty-five percent of the patients had a history of habitual drinking. DM was observed in 22.4% of the cirrhotic patients. In the diabetic group, the frequency of HCV infection was significantly greater. DM did not affect survival. The DM group, however, appeared to have higher mortality in the patients with Child-Pugh class A cirrhosis during long-term follow up. Only 20.6% of the diabetic patients had normal range blood glucose levels even though most of them received medical therapy. The cases with well controlled blood glucose showed higher survival than poorly controlled cases n the DM group. CONCLUSIONS: Cirrhotic patients have a high prevalence of DM, and more frequently are associated with HCV infection. The strict control of blood glucose and the control of infection could be important in prolonging the survival in compensated cirrhotic patients with DM.

Association of chronic hepatitis C virus infection and diabetes mellitus

To determine if there was an association of chronic hepatitis C virus infection with diabetes mellitus Four hundred and forty three patients of chronic hepatitis C virus infection were analyzed retrospectively. These had HCV RNA positive by PCR. Some of these had liver biopsies and quantitative viral loads and hepatitis C serotype performed. Diabetes mellitus was considered to be present if patients were already on diabetes treatment or fasting or random blood sugar indicated diabetes mellitus according to standard criteria. There were 244 males and 199 females patients. Ages ranged from 15 years to 71 years but most were between 21-70. Out of 443 patients, 81 patients [18.28%] had diabetes mellitus. There were 411 patients with chronic hepatitis C and out of these 71 [17.27%] had diabetes mellitus. Thirty-two patients had biopsy proven cirrhosis and 10 of these patients [31.25%] had diabetes mellitus. Out of 71 patients of diabetes with chronic hepatitis C virus infection, 60 [84.5%] had non-insulin dependent diabetes mellitus. Ten patients who had biopsy proven cirrhosis all had non-insulin dependent diabetes mellitus. Patient with chronic hepatitis C virus infection and cirrhosis secondary to hepatitis C virus infection have strong association with diabetes mellitus and great majority of them are non-insulin dependent diabetics

Association between chronic hepatitis C virus infection and diabetes mellitus in Egyptian patients

This study included three groups of patients [284 patients with liver cirrhosis, 93 with type II DM and 63 HBsAg, HCV-Ab and/or HCV-RNA positive blood donors]. All cases had history and clinical examination, abdominal ultrasound, blood glucose, liver function tests, HBsAg and HCV-Ab. HCV-RNA by PCR was performed for 83 cases, islet cell antibodies for 63 and cryoglobulin for 104 cases of liver cirrhosis and glycosylated hemoglobin for 63 seropositive blood donors. The frequency of DM was significantly more in cirrhotic patients with positive HCV-Ab and/or HCV-RNA [40.5%] than those with positive HBsAg [3.3%]. There was no relation between presence of DM and severity of cirrhosis due to HCV, presence of either islet cell antibodies or cryoglobulins. The percentage of blood donors with positive HCV-Ab and/or HCV-RNA who had raised glycosylated Hb 31[68.8%] was significantly more than that with positive HBsAg 3 [16.6%]. The percentage of HCV-Ab was significantly more in patients with type II DM 44 [47.3%] than that of HBsAg 1 [1.1%]

Liver injury in diabetic patients with hepatitis C virus antibodies

Diabetes mellitus [DM] and chronic liver diseases are common allover the world Liver diseases could affect the carbohydrate metabolism and on the other hand, the liver could be affected by DM in the form of fatty liver or even fatty hepatitis. Objectives: The present study was designed: 1] to determine the prevalence of hepatitis C virus antibodies [HCV-AB] in patients with DM [type II], 2] to elucidate the relationship between the possible liver injury and DM and HCV-Ab and 3] to investigate the relationship between HCV-Ab seropositive and markers of the glycometabolic status in diabetics. Methods: The study included a series of 109 patients with DM on oral hypoglycemic drugs, and 91 apparently healthy individuals as controls. Diabetics and controls are enrolled from patients attending the outpatient clinics at Suez Canal University Hospital. No one of the study patients had positive serum for HBsAg or ultrasound findings suggestive of cirrhosis. Sera from all study participants were screened for HCV-Ab, and alanine aminotransferase [ALT] levels Pre- and post-prandial glycaemia were determined by measurement of the fasting blood glucose [FBG] and response of blood glucose levels to 75 g oral glucose [PPG]. Level of fructosamine [FA] was used as an indicator of short-term blood glucose control Quantitative determination of insulin and C-peptide of insulin were carried out using immunoreactive-assay techniques. Results: HCV-Ab was positive in 26.6% of diabetics and 18.7% of non-diabetics. Diabetics had a significantly higher serum ALT level [18.8 +/- 13.9 lU/L] as compared with non-diabetics [15.3 +/- 9.6 lU/L] where P was < 0.05. In logistic regression analysis to detect the main predictors of the elevated ALT, it was found that the HCV-Ab seropositivity is the only significant predictor [P < 0.001], while the other factors [DM, obesity; age, sex] are not significant. It was found that there is no association between HCV-Ab seropositivity and the FBG, PPG. FA, insulin, and C-peptide concentrations in both diabetics and non-diabetics Conclusion: The observed liver damage in diabetics is associated with positive HCV-Ab and not associated with diabetes per se or obesity. HCV-Ab seropositivity does not affect glycemic state. glycemic control level, serum insulin and pancreatic reserve of insulin neither in diabetics nor in healthy individuals