Type II DM & HCV infection (relation and management)

TYPE II DM & HCV

By

Sayed Ahmed Hanzal

Ass, lecturer of Hepato-gastroenterology and tropical medicine

2015

DM

Chronic impairment of glucose metabolism&

the resultant hyperglycemia leads to multiple

organ damage

Caused by insuline (deficiency , resistance or

both)

About 6% of worlds adults are diabetic

About 90% of DM patients are type 2

HCV

Hepatitis C virus (HCV) infection is a major

cause of chronic liver disease, affecting ∼3% of

the world’s population

HCV & DM

Several studies have found a higher prevalence of HCV antibodies in type 2

diabetic patients than expected in the

general population .

HCV & DM

those with HCV infection were more than three times more likely than those without HCV

infection to have type 2 diabetes An increased prevalence of diabetes among

HCV-infected patients with chronic hepatitis

compared with either subjects with other chronic liver disease or the general population has been consistently reported

HOW TO DIAG. DM…???

normal IGT DM

fasting 70---- 110-------126

On 2

occasions

2HPP 140 -------200

HGB A1c 5.7--------6.4

Random

BS

>200 with symptoms

MANAGEMENT

GIVE INSULINE,,,,IF

Decompensated LC

Enzymes >2,5 UL

HGBA1c > 9

Fasting > 240

WHAT ABOUT OTHER DRUGS….??

Medical therapy for patients with type 2 diabetes and liver disease may be the same for patients without liver

disease.

Metformin is first-line therapy for T2DM in

patients with a body mass index > 25

kg/m2.

Insulin secretagogues (eg, gliclazide and

repaglinide) are the second-line therapy

for patients with T2DM. Because they are

metabolized by the liver, their duration of

action may be prolonged in patients with

CLD. Therefore, they should be avoided or

used with caution at low doses in patients

with T2DM and CLD.

SUMMERY An increase of the fasting insulin and a

decrease in insulin sensitivity have been

observed in HCV-infected subjects with a

moderate or severe degree of hepatic fibrosis .

data suggest that HCV is capable of producing

an increase in insulin resistance, even before a

minimal degree of hepatic fibrosis is present

also

both insulin resistance and diabetes can

adversely affect the course of chronic hepatitis

C leading to enhanced steatosis and liver

fibrosis and even increase the risk of

hepatocellular carcinoma