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Insulin Sensitivity and Variability in Hepatitis C Virus Infection Using Direct Measurement

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Abstract

Background and Aims

Studies investigating insulin resistance (IR) in chronic hepatitis C virus (HCV) infection have used surrogate measures of IR that have limited reliability. We aimed to describe the distribution and risk factors associated with IR and its change over time in HCV using direct measurement.

Methods

One hundred two non-cirrhotic, non-diabetic, HCV-infected subjects underwent clinical, histologic, and metabolic evaluation, and 27 completed repeat evaluation at 6 months. Insulin-mediated glucose uptake was measured by steady-state plasma glucose (SSPG) concentration during the insulin suppression test.

Results

Three subjects with diabetes were excluded and 95 completed all testing. SSPG ranged from 39 to 328 mg/dL (mean 135 mg/dL) and was stable over time (mean SSPG change −0.3 mg/dL). SSPG was associated with Latino ethnicity (Coef 67, 95 % CI 37–96), BMI (Coef 19 per 5 kg/m2, 95 % CI 5–32), ferritin (Coef 1.4 per 10 ng/ml, 95 % CI 0.2–2.5), male gender (Coef −48, 95 % CI −80 to −16), and HDL (Coef −16, 95 % CI −28 to −5 mg/dL). Current tobacco use (Coef 55, 95 % CI 19–90), steatosis (Coef −44, 95 % CI −86 to −3), and increases in BMI (Coef 30 per 5 kg/m2, 95 % CI 6–53) and triglyceride (Coef 3.5 per 10 mg/dL, 95 % CI 0.3–6.7) predicted change in SSPG.

Conclusions

There was a wide spectrum of insulin resistance in our HCV population. Host factors, rather than viral factors, appeared to more greatly influence insulin action and its change in HCV.

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Abbreviations

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

BMI:

Body mass index

HCV:

Hepatitis C virus

HDL:

High-density lipoprotein cholesterol

HOMA-IR:

Homeostasis model assessment of insulin resistance

IR:

Insulin resistance

IST:

Insulin suppression test

LDL:

Low-density lipoprotein cholesterol

OGTT:

Oral glucose tolerance test

SSPG:

Steady-state plasma glucose determined by the insulin suppression test

TG:

Triglyceride

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Acknowledgments

This work was supported by National Institute of Health Grant numbers R01 DK074673 (M.K.), UL1 RR024131 (NIH/NCRR UCSF-CTSI), P30 DK026743 (UCSF Liver Center), and the American Diabetes Foundation Grant number 1-08-CR-30 (M.K.).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA

    Nizar A. Mukhtar, Claudia E. Ayala, Jennifer Melgar, Spencer Christensen, Jacquelyn J. Maher & Mandana Khalili

  2. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA

    Peter Bacchetti

  3. Liver Center, University of California San Francisco, San Francisco, CA, USA

    Jacquelyn J. Maher & Mandana Khalili

  4. San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, NH-3D, San Francisco, 94110, CA, USA

    Mandana Khalili

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  1. Nizar A. Mukhtar
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  2. Peter Bacchetti
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  3. Claudia E. Ayala
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  4. Jennifer Melgar
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  7. Mandana Khalili
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Corresponding author

Correspondence to Mandana Khalili.

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Mukhtar, N.A., Bacchetti, P., Ayala, C.E. et al. Insulin Sensitivity and Variability in Hepatitis C Virus Infection Using Direct Measurement. Dig Dis Sci 58, 1141–1148 (2013). https://doi.org/10.1007/s10620-012-2438-3

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  • DOI: https://doi.org/10.1007/s10620-012-2438-3

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