Digestive Diseases and Sciences

, Volume 58, Issue 4, pp 1141–1148

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

  • Nizar A. Mukhtar
  • Peter Bacchetti
  • Claudia E. Ayala
  • Jennifer Melgar
  • Spencer Christensen
  • Jacquelyn J. Maher
  • Mandana Khalili
Original Article

DOI: 10.1007/s10620-012-2438-3

Cite this article as:
Mukhtar, N.A., Bacchetti, P., Ayala, C.E. et al. Dig Dis Sci (2013) 58: 1141. doi:10.1007/s10620-012-2438-3

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.

Keywords

DiabetesHCVInsulin resistanceOral glucose tolerance test

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

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Nizar A. Mukhtar
    • 1
  • Peter Bacchetti
    • 2
  • Claudia E. Ayala
    • 1
  • Jennifer Melgar
    • 1
  • Spencer Christensen
    • 1
  • Jacquelyn J. Maher
    • 1
    • 3
  • Mandana Khalili
    • 1
    • 3
    • 4
  1. 1.Department of Medicine, San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Liver CenterUniversity of California San FranciscoSan FranciscoUSA
  4. 4.San Francisco General HospitalUniversity of California, San FranciscoSan FranciscoUSA