Replacing Insulin with Anti-Virals: A Clinical Vignette on Diabetes and HCV Treatment

• Main Authors: Justin Berk, MD, MPH, MBA, Ting-Jia Lorigiano, MD, MBA, Mark Sulkowski, MD, Sara Mixter, MD, MPH
• Format: Article
• Language: English
• Published: Elsevier 2020-03-01
• Series: AACE Clinical Case Reports
• Online Access: http://www.sciencedirect.com/science/article/pii/S2376060520300523

ABSTRACT: Objective: There is growing evidence to support a connection between type 2 diabetes mellitus (T2DM) and chronic hepatitis C virus (HCV). Patients with hepatitis C have a substantially higher risk for developing type 2 diabetes and recently there have been several proposed mechanisms. Several retrospective studies have demonstrated a small but significant improvement in glycemic control after treatment of underlying hepatitis C virus. We describe a case that demonstrates the greatest recorded improvement in glycemic control after treatment of HCV in the setting of self-discontinuation of insulin therapy without behavioral modification. Methods: A 38-year-old obese female with uncontrolled T2DM (hemoglobin A1c [HbA1c] of 11.6% [103 mmol/mol]) was temporarily lost to follow-up and reported nonadherence to insulin therapy, metformin therapy, diet, or exercise. During this time, she was successfully treated for hepatitis C and became euglycemic without other interventions. Results: The patient's HbA1c decreased from 11.6 to 5.7% (103 to 39 mmol/mol) in the presence of weight gain and in the absence of any intervention other than hepatitis C treatment. Conclusion: Hepatitis C treatment may offer significant potential for improving insulin sensitivity and decreasing long-term complications of type 2 diabetes in certain patients. Universal treatment of HCV could offer benefits in both hepatic and extrahepatic clinical outcomes.