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Original Research: Arch G. Mainous, III, Vanessa A. Diaz, Dana E. King, Charles J. Everett, and Marty S. Player The Relationship of Hepatitis Antibodies and Elevated Liver Enzymes with Impaired Fasting Glucose and Undiagnosed Diabetes J Am Board Fam Med 2008; 21: 497-503 [Abstract] [Full text] [PDF]

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The relationship of hepatitis antibodies and elevated liver enzymes with impaired fasting glucose

Paula P Cox-North   (2 December 2008)

The relationship of hepatitis antibodies and elevated liver enzymes with impaired fasting glucose 2 December 2008
Paula P Cox-North, ARNP-Doctoral Student Pacific Medical Centers Send response to journal: Re: The relationship of hepatitis antibodies and elevated liver enzymes with impaired fasting glucose paulac{at}u.washington.edu Paula P Cox-North	I enjoyed reading your article on elevated liver enzymes and undiagnosed diabetes. In the literature there have been several hypotheses to explain the correlation of hepatitis and diabetes. One hypothesis that the more advanced the liver fibrosis the higher the risk for diabetes due to impaired glucogenesis by the liver 3. Some more recent studies show that in particular hepatitis C may interfere with insulin receptor substrate 1 and 2 through increased levels of pro-inflammatory cytokines4. This hypothesis of HCV and diabetes has not consistently been demonstrated in clinical trials. In post treatment longitudinal trials, those with a history of HCV that develop DM also have other risk factors such as increased age, increased BMI, and family history of DM all individual predictors of insulin resistance, which distorts this hypothesis of whether or not HCV can be directly implicated in the development of diabetes type 2 2. In people with fatty liver disease without hepatitis C we have seen as well that increased age, BMI, and family history of DM are all individual predictors of insulin resistance and pre-diabetes 1. In your article you state that increased ALT and GGT could be considered a precursor to pre-diabetes but given what we know about liver steatosis and insulin resistance I cannot help but wonder if increased ALT and GGT is rather just a symptom of steatosis caused by insulin resistance. References: Clark, J.M., (2006). Epidemiology of Non Alcoholic Fatty Liver Disease in Adults. Journal of Clinical Gastroenterology, 40,S5-10. Giordinino, C., Bugianesi, E., Smedile, A., et al.,(2008). Incidence of Type 2 Diabetes Mellitus and Glucose Abnormalities in Patients With Chronic Hepatitis C Infection by Response to Treatment: Results of a Cohort Study. American Journal of Gastroentrology,103,2481-248, doi: 10.1111/j.1572-0241.2008.02002.x 3. Mehta SH, Brancati FL, Sulkowski MS, et al.,(2000). Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Annals of Internal Medicine, 133:592–599. 4. Kawaguchi T, Yoshida T, Harada M, et al.,(2004).Irus downregulates insulin receptor substrates 1 and 2 through upregulation of suppressor of cytokine signaling 3.American Journal of Pathology,165:1499–1508.