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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 31  |  Issue : 1  |  Page : 19-22

Profile of glucose intolerance in chronic hepatitis B virus infection


1 Department Medicine, RIMS, Imphal, Manipur, India
2 Department Community Medicine, RIMS, Imphal, Manipur, India

Date of Web Publication17-Jan-2017

Correspondence Address:
Konsam Biona Devi
Department of Medicine, RIMS, Imphal, Manipur
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.198431

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  Abstract 

Background: The prevalence of diabetes mellitus and impaired glucose tolerance is higher in patients with cirrhosis of any cause than in the general population. Hepatitis B infection is one of the causes. Objectives: To study the prevalence of glucose intolerance in chronic hepatitis B (CHB) virus (HBV) infection and to find out the association between glucose intolerance and severity of fibrosis, genotype, and HBV DNA levels. Materials and Methods: The study was a retrospective cohort type conducted in the Department of Medicine, Regional Institute of Medical Sciences, which included 29 patients. Fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were performed. HBV DNA levels and genotype were determined. Liver fibrosis was assessed by fibroscan. Results: The number of patients with impaired and diabetic range of FBS was 5 (17.2%) and 7 (24.1%), respectively. Similarly for PPBS, 8 (27.6%) patients had impaired range and 11 (37.9%) patients with diabetic range. Glycated hemoglobin (HbA1C) value ≥5.7 was present in 20 (69%) patients. A majority of patients were found to have genotype C (72.4%). Comparison for association between patients having impaired and diabetic range of FBS, PPBS, and HbA1C with fibroscan value >12.5 kPa was found to be statistically significant but that of genotype and HBV DNA levels was not considered significant. Conclusion: The prevalence of glucose intolerance is increased in patients with CHB infection. Patients having severe fibrosis or cirrhosis of the liver are found to be more glucose intolerant.

Keywords: Fibroscan, genotype, glucose intolerance, hepatitis B virus DNA


How to cite this article:
Singh N B, Devi KB, Sharma H D, Chhangte L, Kharbuli I, Salih SR. Profile of glucose intolerance in chronic hepatitis B virus infection. J Med Soc 2017;31:19-22

How to cite this URL:
Singh N B, Devi KB, Sharma H D, Chhangte L, Kharbuli I, Salih SR. Profile of glucose intolerance in chronic hepatitis B virus infection. J Med Soc [serial online] 2017 [cited 2020 May 25];31:19-22. Available from: http://www.jmedsoc.org/text.asp?2017/31/1/19/198431


  Introduction Top


The prevalence of diabetes mellitus and impaired glucose tolerance (IGT) is higher in patients with cirrhosis of any cause than in the general population. [1],[2],[3],[4] The prevalence of diabetes in patients with chronic hepatitis B (CHB) virus (HBV) infection has also been investigated in several studies. In the absence of cirrhosis, it varies from 1.9% to 14%, which is not different from that reported in the general population. [3],[5],[6],[7],[8]

The aim of the study was to compare the prevalence of glucose intolerance in chronic HBV infection.


  Materials And Methods Top


It was a retrospective cohort study conducted in the Department of Medicine, Regional Institute of Medical Sciences. A total of 29 CHB-infected patients who either attended medicine out-patient department or admitted to medicine ward between December 2013 and May 2014 were studied. The diagnosis of CHB was based on the presence of hepatitis B surface antigen positivity for more than 6 months. Exclusion criteria were patients with prior antiviral treatment, established diabetes, concurrent HBV, and hepatitis C virus infection; patients receiving drugs or having conditions that cause fatty liver (tamoxifen, steroids, amiodarone, diltiazem, gastrointestinal bypass surgery, or severe recent weight loss), regular or excessive alcohol consumption; obese patients; pregnant and lactating women.

In the spectrum of glucose intolerance, the following were included: (i) IGT defined as fasting blood sugar (FBS) of 110-125 mg/dL and postprandial blood sugar (PPBS) of 140-199 mg/dL, (ii) diabetes detected for the first time defined as FBS ≥126 mg/dL and PPBS level ≥200 mg/dL.

In all the patients, fasting plasma glucose and postprandial plasma glucose samples were obtained. HbA1C, serum alanine aminotransferase, serum aspartate aminotransferase, and α-fetoprotein were done for all the patients. Hepatitis B e antigen status, HBV DNA, and genotype were determined by a commercially available assay.

Fibroscan (transient elastography) is performed in all the patients. It is a noninvasive, rapid, and reproducible method, allowing evaluation of liver fibrosis by the measurement of liver stiffness. It is expressed in kilopascal (kPa).

Data collected were analyzed using the Statistical Package for Social Sciences (SPSS Inc., Chicago, IL, USA) Windows based version 21.0. Descriptive statistical analysis was used in the study. Chi-square test and Student's t-test were used for comparison analysis. P < 0.05 was considered statistically significant.


  Results Top


The present study included 29 patients. Age-wise distribution is shown in [Figure 1]. The age ranged from 12 to 60 years. A majority of patients were in the age group of 21-30 years accounted for 31% and age group of 31-40 years accounted for 24.1%. Among the others, 20.7% were between 11 and 20 years, 17.2% between 41 and 50 years, and 6.9% between 51 and 60 years. Gender-wise distribution of male and female was 58.6% and 41.4%, respectively, as shown in [Figure 2].
Figure 1: Age distribution

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Figure 2: Gender distribution

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[Table 1] shows the glucose parameters of patients with chronic HBV infection. The number of patients with impaired and diabetic range of FBS was 5 (17.2%) and 7 (24.1%), respectively. Similarly, for PPBS, 8 (27.6%) patients had impaired range and 11 (37.9%) patients with diabetic range. Glycated hemoglobin (HbA1C) value ≥5.7 were present in 20 (69%) patients.
Table 1: Glucose parameters


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In the study, genotype of HBV observed was either type C or type D. A majority of patients were found to have genotype C (72.4%) and the rest were genotype D (27.4%) as shown in [Figure 3].
Figure 3: Genotype distribution

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Comparison for association between patients having impaired and diabetic range of FBS, PPBS, and HbA1C with fibroscan value >12.5 kPa was found to be statistically significant. The number of patients with fibrosis ≥12.5 kPa was 7; all of them (100%) had FBS ≥110, PPBS ≥140, and HbA1C ≥5.7. Details are shown in [Table 2].
Table 2: Comparison between glucose intolerant patients and fibroscan, genotype, and hepatitis B virus DNA

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The number of genotype C patients was 21, in which 10/21 had FBS ≥110, 15/21 had PPBS ≥140, and 14/21 had HbA1C ≥5.7. The number of patients with genotype D was 8, in which 2/8 had FBS ≥110, 6/8 had PPBS ≥140, and 6/8 had HbA1C ≥5.7. However, these results were not found to be significant. Details are shown in [Table 2].


  Discussion Top


In the study, the prevalence of glucose intolerance in patients with CHB was significantly higher which is in accordance with the findings reported by Mavrogiannaki et al. [9] Since a known diabetic patient was also excluded in the study, glucose intolerance was a new development in these patients. Therefore, glucose intolerance might be associated with CHB infection. In the absence of cirrhosis, prevalence varied from 1.9% to 14%, which is not different from that reported in the general population. [3],[5] However, in present study, the prevalence was found to be 65.5% considering postprandial plasma glucose.

According to the study conducted by Foucher et al., [10] a cutoff of 7.2, 12.5, and 17.6 kPa was taken for the diagnosis of moderate fibrosis, severe fibrosis, and cirrhosis of the liver, respectively. In this study, the value of 12.5 kPa or more was taken which include patients having severe fibrosis as well as cirrhosis of the liver. Hence, patients with either severe fibrosis or cirrhosis of the liver were observed to have significantly higher blood glucose level ranging from impaired to overt diabetes.

Genotype of the hepatitis B in this study was either genotype C or D. Genotype was compared with blood glucose level, but there was no significant association between them. Similarly, for HBV DNA level, comparison between levels of ≥20,000 IU/ml with blood glucose did not give a significant result.

The limitation of the study was small sample size. This might be one of the reasons for not getting a significant result considering other variables such as genotype and HBV DNA levels.


  Conclusion Top


The prevalence of glucose intolerance was increased in patients with CHB infection. Moreover, patients having severe fibrosis or cirrhosis of the liver were found to be more glucose intolerant though genotype and HBV DNA levels had no significant relation with blood glucose levels.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Megyesi C, Samols E, Marks V. Glucose tolerance and diabetes in chronic liver disease. Lancet 1967;2:1051-6.  Back to cited text no. 1
    
2.
Petrides AS, Vogt C, Schulze-Berge D, Matthews D, Strohmeyer G. Pathogenesis of glucose intolerance and diabetes mellitus in cirrhosis. Hepatology 1994;19:616-27.  Back to cited text no. 2
    
3.
Huo TI, Wu JC, Lee PC, Tsay SH, Chang FY, Lee SD. Diabetes mellitus as a risk factor of liver cirrhosis in patients with chronic hepatitis B virus infection. J Clin Gastroenterol 2000;30:250-4.  Back to cited text no. 3
    
4.
Nishida T, Tsuji S, Tsujii M, Arimitsu S, Haruna Y, Imano E, et al. Oral glucose tolerance test predicts prognosis of patients with liver cirrhosis. Am J Gastroenterol 2006;101:70-5.  Back to cited text no. 4
    
5.
Huang JF, Dai CY, Hwang SJ, Ho CK, Hsiao PJ, Hsieh MY, et al. Hepatitis C viremia increases the association with type 2 diabetes mellitus in a hepatitis B and C endemic area: An epidemiological link with virological implication. Am J Gastroenterol 2007;102:1237-43.  Back to cited text no. 5
    
6.
Mason AL, Lau JY, Hoang N, Qian K, Alexander GJ, Xu L, et al. Association of diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999;29:328-33.  Back to cited text no. 6
    
7.
Caronia S, Taylor K, Pagliaro L, Carr C, Palazzo U, Petrik J, et al. Further evidence for an association between non-insulin-dependent diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999;30:1059-63.  Back to cited text no. 7
    
8.
Papatheodoridis GV, Chrysanthos N, Savvas S, Sevastianos V, Kafiri G, Petraki K, et al. Diabetes mellitus in chronic hepatitis B and C: Prevalence and potential association with the extent of liver fibrosis. J Viral Hepat 2006;13:303-10.  Back to cited text no. 8
    
9.
Mavrogiannaki A, Karamanos B, Manesis EK, Papatheodoridis GV, Koskinas J, Archimandritis AJ. Prevalence of glucose intolerance in patients with chronic hepatitis B or C: A prospective case-control study. J Viral Hepat 2009;16:430-6.  Back to cited text no. 9
    
10.
Foucher J, Chanteloup E, Vergniol J, Castéra L, Le Bail B, Adhoute X, et al. Diagnosis of cirrhosis by transient elastography (FibroScan): A prospective study. Gut 2006;55:403-8  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]


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