Insulin and glutamic acid decarboxylase antibodies in chronic hepatitis [C] patients with diabetes mellitus

ABSTRACT

Diabetes mellitus is associated more with HCV chronic liver disease than in the general population and in the other types of chronic liver disease. The increased incidence of diabetes in HCV patients might be related to an autoimmune process produced by the virus or the virus itself has a cytopathic effect on the pancreatic beta clells. The aim of this work was to study the plasma basal insulin level and the seropositivity against glutamic acid decarboxylase [GADA] - an islet cell cytoplasmic antigen. Patients the study was carried out on 45 patients categorized into 3 equal groups. Group I included 15 diabetic patient with HCV chronic liver disease, Group II included 15 diabetic patients with chronic liver disease which is not related to HCV, Group III included 15 non diabetic patients with HCV chronic liver disease. All patients were selected to be matched regarding age, sex and sevirity of liver disease. The results showed that basal insulin level [22.4 +/- 23.1 micro IU/ml in group I, 21.6 +/- 23.8 micro IU/ml in group II, and 8.8 +/- 6.4 micro IU/ml in group III] were significantly higher in the diabetic patients [GI and GII] compared to the non diabetic [GIII] [P<0.01]. The insulin resistance index as calculated by HOMA equation [9.6 +/- 7.9 in group I, 9.2 +/- 10.3 in group II and 2.4 +/- 1.2 in group III], were also significantly higher in the diabetic groups [p < 0.01]. Seropositivity for [GADA] was 9/15 [60%] of patients of groups I and III and 3/15 [20%] of patients of group II. We concluded that diabetes mellitus associated with HCV chronic liver disease in characterized hyperinsulinaemia and increased insulin resistance. There may be a role of autoimmunity in the pathogenesis of diabetes in HCV chronic liver disease. Follow up of the non diabetic HCV patients with positive GADA for development of diabetes is recommended