June 15, 2014
SAN FRANCISCO — Provocative new data support an intriguing hypothesis: that vaccinating people against hepatitis B may prevent diabetes from developing, at least in some individuals.
Using participants from the NHANES study 2005–2010, researchers from California examined more than 7000 subjects without a prior history of diabetes; around 1400 of them had previously been vaccinated with hepatitis B, and these individuals had a 52% reduction in the risk for subsequent diabetes compared with individuals not vaccinated, even after adjustment for all potential confounders.
Horng-Yih Ou, MD, from City of Hope National Medical Center, Duarte, California, reported the findings during a guided poster session at the American Diabetes Association (ADA) 2014 Scientific Sessions yesterday.
"The study showed people vaccinated with hepatitis B have a much lower risk for diabetes," senior author Ken C. Chiu, MD, from the department of diabetes, endocrinology, and metabolism at the Beckman Research Institute, Duarte, California, told Medscape Medical News in an interview.
"If we can vaccinate patients effectively, there's a good chance for us to reduce the chance of diabetes by at least 50%," he added.
Dr. Chiu acknowledged that this is a controversial theory but said it's easily tested and that an intervention trial is now needed to further investigate this; his group is trying to get one off the ground.
"It would be so simple to do, we are thinking about it, and we are looking for a place that extensively vaccinates people against hepatitis B," he explained. The experiment would involve immunizing half of the participants for hepatitis B and not the remainder and following the individuals long term to compare diabetes rates, he noted.
Diabetes Differed Significantly Between Vaccinated and Nonvaccinated
Dr. Chiu explained that infection has been implicated in the pathogenesis of diabetes, and he notes than an association between the condition and hepatitis C is well recognized. Insulin resistance associated with hepatitis C infection has been inferred to play a role in the process. And the presence of the hepatitis C virus in pancreatic beta-cells has been linked with morphological cell changes and beta-cell dysfunction, he added.
"But no association with hepatitis B has been reported to date," Dr. Ou told delegates.
The group therefore decided to look for any similar association between hepatitis B and diabetes. They examined adult subjects from NHANES who had information available on both fasting blood glucose and hepatitis B status. Those with established diabetes were excluded.
Dr. Chiu noted that because they used fasting blood glucose only to determine diabetes status, they could not differentiate between types 1 and 2 diabetes, but due to the fact they were studying an adult population, the diabetes identified was likely predominantly type 2.
And to rule out people with hepatitis B, they specifically looked at those who were positive for hepatitis B surface antibody but negative for hepatitis B core antibody, "which means they are vaccinated, not infected," he explained.
Of 7142 subjects with no history of diabetes, 1412 were noted to be successfully vaccinated against hepatitis by the above assessment.
Diabetes was defined as fasting plasma glucose higher than 126 mg/dL, and the distribution of the disease "differed significantly between the subjects with and without vaccination," Dr. Ou said during in his poster presentation.
Diabetes occurred in 16 subjects (1.13%) with hepatitis B vaccination and 325 individuals (5.67%) without immunization.
This equated to a massive 81% reduction in diabetes risk, but Dr. Ou noted that those who received the hepatitis B vaccination were more likely to be female, younger, leaner by body mass index (BMI), with lower fasting plasma glucose, and were less likely to drink alcohol than those who were not immunized.
But even after multivariate adjustment for all potential variables, including age, gender, BMI, smoking status, physical activity, and race, the protective effect of hepatitis B vaccination was still large, with an odds ratio of 0.48 (95% confidence interval 0.28–0.82).
"To our knowledge this is the first report that hepatitis B vaccination could reduce the risk of diabetes in multiple racial/ethnic groups," Dr. Ou told attendees, adding that "a prevention trial is warranted."
The authors have reported no relevant financial relationships.
American Diabetes Association 2014 Scientific Sessions; June 14, 2014. Abstract 1488-P