February 6, 2014

The Relationship of Hepatitis C Virus Infection with Diabetes in the United States Population


Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)


Constance E. Ruhl M.D., Ph.D.1,*, Andy Menke Ph.D.1, Catherine C. Cowie Ph.D.2,  James E. Everhart M.D., M.P.H.2

DOI: 10.1002/hep.27047

Copyright © 2014 American Association for the Study of Liver Diseases

Publication History
Accepted manuscript online: 5 FEB 2014 10:25AM EST
Manuscript Accepted: 31 JAN 2014
Manuscript Revised: 5 DEC 2013
Manuscript Received: 20 SEP 2013

Keywords: insulin resistance; alanine aminotransferase;  gamma glutamyltransferase;  National Health and Nutrition Examination Survey;  epidemiology


An association of hepatitis C virus (HCV) infection with diabetes has been reported in many studies, but few have been population-based and applied standard criteria for diabetes diagnosis. We examined this relationship using recent population-based data from the U.S. National Health and Nutrition Examination Survey. 15,128 adult participants in the 1999-2010 surveys had data on diabetes status and serum HCV antibody (anti-HCV) or HCV RNA. Using American Diabetes Association criteria, diabetes was defined as a health care provider diagnosis, serum hemoglobin A1C (A1C) ≥6.5%, or fasting plasma glucose (FPG) ≥126 mg/dL; pre-diabetes as A1C 5.7%-<6.5% or FPG 100-<126 mg/dL; and normal glucose as A1C <5.7% and FPG <100 mg/dL. Odds ratios (OR) for diabetes and pre-diabetes, comparing persons with HCV infection to those without, were adjusted for demographics, BMI, C-reactive protein, smoking, drinking, and blood transfusion before 1992. Among participants without diabetes, we compared mean insulin resistance, estimated using homeostasis model assessment (HOMA-IR), by HCV status. The overall prevalence of anti-HCV+ was 1.7%, of HCV RNA+, 1.1%, of diabetes, 10.5%, and of pre-diabetes, 32.8%. The prevalence of diabetes and pre-diabetes did not differ by HCV status. In multivariate-adjusted analysis, diabetes remained unassociated with anti-HCV (OR=1.0, 95% confidence interval (CI), 0.6-1.7) or with HCV RNA (OR=1.1, 95% CI, 0.6-1.9). In contrast, elevated alanine aminotransferase and gamma glutamyltransferase activities were associated with diabetes regardless of HCV status. HOMA-IR was not associated with HCV markers in unadjusted or multivariate-adjusted analyses (p>0.05). Conclusion. In the U.S. population, HCV was not associated with diabetes, or with insulin resistance among persons with normal glucose. Previously reported relationships of HCV with diabetes were possibly attributable to the effect of elevated liver enzymes. (Hepatology 2014;)


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