Treatment of Hepatitis C Virus and Long-Term Effect on Glycemic Control.

BACKGROUND: Chronic hepatitis C virus (HCV) infection has been linked to worsening glycemic control in patients with diabetes due to insulin resistance. Studies have shown that treating HCV improves glycemic control in this patient population. Most studies assess glycemic control until the patient's sustained viral response at 12 weeks (SVR12). OBJECTIVES: To (a) assess the sustainability of glycemic control after the SVR12 date and (b) determine the change in diabetic medication use over time. METHODS: This was a retrospective chart review of patients treated at an academic medical center's hepatology clinic from 2014 through 2017. Patients were eligible for review if they were treated for hepatitis C and had type 2 diabetes mellitus (DM) or pre-DM, defined by a hemoglobin A1c (A1c) >5.7%, at baseline. Data were collected from the EPIC database available to Temple University Hospital. Results were analyzed using a linear mixed model and descriptive statistics. RESULTS: Of the 1,073 patients screened, 310 met the eligibility criteria. Most patients achieved SVR12 (87.8%). A statistically significant decrease in A1c from baseline to treatment completion with direct-acting antivirals (DAAs) and until current reading was seen (P< 0.05). Overall, A1c was reduced in patients treated for HCV with DAA by -0.27% (95% CI=-0.479% to -0.055%, P= 0.014) from baseline to current reading. No statistically significant difference existed in A1c at time of SVR12 to current reading (difference in A1c =0.07%, 95% CI=-0.26% to 0.4%, P=0.67), indicating that the reduction in A1c achieved by treating HCV can be sustained over time. Insulin dose also decreased from baseline to current values. CONCLUSIONS: Overall, patients with diabetes successfully treated for the hepatitis C virus may be able to maintain improved glycemic control past SVR12. This could lead to less antidiabetic medication use and decreased insulin requirements for this patient population. Copyright (C) 2020, Academy of Managed Care Pharmacy. All rights reserved.