THE FREQUENCY OF HEPATITIS C IN THE PATIENTS OF TYPE II DIABETES MELLITUS WITH GOOD GLYCEMIC CONTROL VERSUS POOR GLYCEMIC CONTROL.
Objective: To determine the frequency of hepatitis C in the patients of type II diabetes mellitus with Good glycemic control versus Poor glycemic control.
Study Design: A cross sectional observational study.
Place and Duration of Study: Departfment of Medicine, Military Hospital, Rawalpindi, from 20-02-2012 to 19-08-2012.
Material and Methods: A total of 175 cases of Type II diabetes were included in thestudy, They were advised anti HCV antibodies(anti hepatitis C antibodies) by 3rd generation ELISA and Glycosylated-hemoglobin (HBA1C).On basis of HBA1C they were divided in two groups, Poorly control diabetes HBA1C >7% and good control diabetes HBA1C<7%.Data was analyzed using SPSS Version 13.0.Mean and standard deviation was calculated for quantitative variables like age .Frequency and percentages were calculated for qualitative variables like gender and HCV status. Chi-square test was applied to determine the differences in proportion of anti-HCV antibodies in two groups. p-value 0.7958) association between glycemic control and HCV infection.
Conclusion: The frequency of HCV infection in type II diabetic patients is 14.9% so that risk of getting HCV infection is increased in diabetics but it is not associated with glycemic control.
Keywords: Glycemic control, Hepatitis C, HbA1C, Type II diabetes.
Type II diabetes mellitus (Type II DM) and Hepatitis C (HCV) infection are among the most common diseases involving around 170 and 130 million people worldwide respectively 1. Pakistan has intermediate hepatitis C prevalence, 10 million people in Pakistan are suffering from HCV infection and prevalence rate of HCV is 6% in Pakistan2. Approximately 70% cases of chronic liver disease and 50% cases of Hepatocellular carcinoma in the countryare due to chronic HCV infection2. HCV infection has hepatic and systemic manifestations such as insulin resistance, essential mixed cryoglobulinemia, glomerulonephritis, porphyria cutanea-tarda and benign monoclonalgammopathy2,3.
Diabetes is a considerable public health issue in the country. Pakistan has 7.1 million patients of diabetes which will be rise to 13.8 million in next decade4. The hypothesis that HCV may associated with type II diabetes mellitus was first presented by Allison in 19994,5 since then studies assessing the connection between HCV and type II DM have been performed, but these studies have provided unclear data, with some studies supporting that type II DM is increased the risk of HCV infection compared to non-diabetic controls5,6, and some studies showed no association between HCV infection and type II DM7,8. Moreover, the association of HCV infection with diabetes-related complications has not yet been clarified5.
This study was design to determine the risk of diabetic patients to acquired HCV infection and question the answer wither well controlled DM HbA1C (Glycosylated-hemoglobin) <7 or poorly controlled DM, HBA1C more than 7 have effects on infectivity of HCV.
MATERIAL AND METHODS
This cross sectional study was performed in Department of General Medicine, Military Hospital, Rawalpindi from 20-02-2012 to 19-08-2012. Approval from hospital ethical committee was obtained. Written consent was taken from patients. In the study we included diagnosed/treated cases of type II diabetes for 7.0%, Good controlled Type II DM: HbA1C<7.0%.Hepatitis C was define by detection of anti-HCV antibodies by 3rd generation ELISA. The results were verified by a pathologist. All data was analyzed using SPSS Version 13.0.Mean and standard deviation (mean +- SD) was calculated for quantitative variables like age. Frequency and percentages were calculated for qualitative variables like gender and HCV status. Chi-square test was applied to determine the differences in proportion of anti-HCV antibodies in two groups. A p-value <0.05 was considered as significant.
Table-1 Comparison of hepatitis C in good and poor glycemic control.
###Good glycemic control###Poor glycemic control
Hepatitis C virus###p-value
In this study 175 patients of type II diabetes mellitus were included, which were further divided into two groups patients with well glycemic control and poor glycemic control on the basis of HbA1C.
As regards to age distribution, majority of the patients were middle age ( 41 to 60 years of age). Mean age of the patients was 54.5 +- 7.9 years.
In our study sample of 175 patients, 83 patients (47.4%) were male while 92 patients (52.6%) were female.
Hepatitis C infection was found in 26 cases (14.9%) of type II diabetic patients. Out of these 26 HCV infected cases, 16(61.5%) were male and 10 (38.5) were female.
Regarding glycemic control, 37 patients (21.1%) were having good glycemic control while remaining 138 patients (78.9%) belonged to poor glycemic control group. HCV infection was observed in 5 (13.5%) patients of good glycemic control group and in 21 (15.5%) patients of poor glycemic control group (table-1). The analysis by chi-square test shows that there was no significant (p-value 0.7958) association between glycemic control and HCV infection.
Hepatitis C is a growing public health issue, it infects 3% population world wide. HCV infection become chronic in 80% cases 10. The intensity and rate of progression to chronic disease depends on host related and disease related factors11.
The association between the hepatitis C and Type II DM was discovered by Allison et al in 1994 and then explored by Simo et al in 199612,5.
The concept that patients with type II DM have excessive parenteral exposures due to regular blood sugar monitoring increased the of risk HCV infection was rejected by Rudoni S, et al13. Our study indicates that patients with type II DM has increased prevalence of HCV infection 14.9% , whereas prevalence of HCV is 6 % in general papulation2 . Our study established the presence of type II DM has a risk factor for HCV infection. In a study conducted by Momen et al prevalence rate of HCV in diabetics was 31.5% which is higher than our study14. Our results are in contrast to a study from Karachi Pakistan in which Qureshi et al15 reported the frequency of HCV is 1.8% in type II DM. Another local study by Khakar et al16 showed that prevalence of HCV infection in diabetics to be 17.27%. The reason for this difference may be increasing prevalence of HCV infection in our community or studies were performed in different district of Pakistan.
In the present study mean age was 54.5 +- 7.9, it was noted "that with increasing age chance of infected with HCV was increased" which is in consistent with past studies17.
Our study showed hepatitis C infection rate higher in males (61.5%) than female (38.5%). This agrees with the work of Caronia et al which showed that male patients of type II DM are more likely to contact hepatitis C infections as compared to females18.
In spite of the growing number of reports showing a link between hepatitis C infection and type II DM, the association of HCV infection with diabetes related complications has not yet been clarified. In our study HCV infection was observed in 5 (13.5%) patients of good glycemic control group and in 21 (15.5%) patients of poor glycemic control group .This showed that there was no significant association between glycemic control and HCV infection in contrast with study conducted by Chehadeh W et al9.
The small sample size was one of the limitation of the study, therefore a study on a larger scale is required to authenticate the prevalence of HCV infection in patients of type II DM.
The frequency of HCV infection in type II diabetic patients is 14.9% so that risk of getting HCV infection is increased in diabetics but it is not associated with glycemic control.
CONFLICT OF INTEREST
The authors of this study reported no conflict of interest.
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|Publication:||Pakistan Armed Forces Medical Journal|
|Date:||Feb 29, 2016|
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