High prevalence of diabetes mellitus among adult β-thalassaemic patients with chronic hepatitis C

Abstract

The aim of this study was to assess the prevalence of diabetes mellitus in patients with hepatitis C virus (HCV) chronic hepatitis and secondary haemochromatosis as a consequence of beta-thalassaemia major. This group of patients was studied in order to reveal subtle effects of early stages of HCV infection on glucose metabolism, made more apparent by the coexistence of the diabetogenic effect of haemochromatosis. The study included 108 beta-thalassaemic multitransfused patients, 55 females and 53 males, age 26.8+/-9 years. Sixty-four patients were seropositive for HCV by ELISA-3 (61/64 HCV-polymerase chain reaction-positive by Amplicor). In 51 of these, chronic hepatitis C was documented by liver biopsy, which also showed incomplete cirrhosis for eight and cirrhosis for four patients. Diabetes was diagnosed according to the criteria of the National Diabetes Data Group of the National Institutes of Health. (1) Patients with thalassaemia and HCV infection were diabetic more often than thalassaemic patients without HCV infection (45.3% versus 11.3%; P<0.001). This highly significant difference was also found when patients with definite cirrhosis or incomplete cirrhosis were excluded (41% versus 11.3%; P<0.01). (2) The high frequency of diabetes in thalassaemic patients with HCV chronic hepatitis is not related to body mass index or iron load, but it seems especially evident in patients over 25 years of age (50% of HCV-positive were diabetic versus 9.5% of HCV-negative; P<0.01). The frequency of diabetes in adult thalassaemic patients is significantly increased by HCV infection, even in the absence of cirrhosis. It is probable that the coexistence of haemochromatosis makes the effect of HCV infection on glucose metabolism clinically evident, even in the stage of chronic hepatitis.