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Managing Gastrointestinal Complications of Diabetes pp 93–105Cite as

Diabetes, Specific Hepatobiliary Diseases, and Treatment

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Abstract

There is an increased prevalence of diabetes mellitus in the hepatitis C (HCV)-infected population [1, 2]. In a cross-sectional national survey, persons 40 years of age or older with HCV infection were more than three times more likely to have type 2 diabetes than those without HCV [2]. Given the epidemiologic evidence, there has been a speculation as to whether HCV itself plays a more direct role in the development of diabetes. In a retrospective study involving over 1,100 patients, diabetes was seen in 21 % of HCV-infected patients, compared with only 12 % of noninfected patients [3]. This study suggests that the diabetes is related specifically to HCV infection, as opposed to liver disease in general. Additionally, patients who underwent liver transplantation were far more likely to develop posttransplantation diabetes if the cause of liver disease was related to HCV [4], further suggesting that HCV is directly involved in the pathogenesis of diabetes. The relationship between HCV and diabetes has been studied closely, and there are three distinct processes that have been described [1]. First, insulin resistance and diabetes may simply be a result of progressive fibrosis caused by chronic HCV infection. Second, chronic HCV results in increasing hepatic steatosis, which leads to the development of insulin resistance. Third, chronic HCV may have a direct cytopathic effect on insulin sensitivity. Specifically, Masini and colleagues showed the presence of HCV-positive islet cells in patients with chronic HCV infection. These islet cells demonstrated certain morphological changes as well as reduced in vitro glucose-stimulated insulin release [5]. Thus, insulin resistance and diabetes may occur as a result of various direct viral or host-dependent pathways working independently or synergistically.

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  1. Ben Taub General Hospital, 5th Fl (5-PO 71 002b) 1504 Taub Loop, Houston, TX, 77030, USA

    Michael Lin & S. Chris Pappas

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  1. Baylor College of Medicine, Houston, Texas, USA

    Joseph Sellin

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Lin, M., Pappas, S.C. (2017). Diabetes, Specific Hepatobiliary Diseases, and Treatment. In: Sellin, J. (eds) Managing Gastrointestinal Complications of Diabetes. Adis, Cham. https://doi.org/10.1007/978-3-319-48662-8_7

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  • DOI: https://doi.org/10.1007/978-3-319-48662-8_7

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  • Publisher Name: Adis, Cham

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