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Association of Hepatitis C and Diabetes Mellitus
- Shruti H. Mehta, MPH;
- Mark S. Sulkowski, MD; and
- David L. Thomas, MD, MPH
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IN RESPONSE:
We agree with Drs. Knobler and Schattner that histologic examination of the liver in HCV-infected persons with and without type 2 diabetes mellitus contributes to our understanding of the relationship between these conditions. Previous studies have demonstrated that community-identified HCV infection is not usually associated with cirrhosis (1). Thus, we would not anticipate finding a high prevalence of cirrhosis among HCV-infected persons identified in a community setting, such as the participants in NHANES III. While this could not be confirmed in our analysis because liver biopsies were not performed in NHANES, the assumption is supported by a study by Knobler and coworkers, which demonstrated an association between HCV infection and type 2 diabetes mellitus in persons in whom cirrhosis was excluded by biopsy [2]). The biological mechanism of this association remains to be explained.
Several investigators, including Dr. Paris, have suggested iron overload as a possible explanation for the increased prevalence of type 2 diabetes mellitus among persons with HCV infection. Labropoulou-Karatza and colleagues (3) specifically examined serum ferritin levels among adults with β-thalassemia and found that they had no effect on the relationship between HCV infection and diabetes. Similarly, in our study, serum ferritin levels did not affect the results of the multivariable analysis. Our results were comparable to those of Dr. Paris in that serum ferritin levels were elevated among persons with HCV infection and among those with type 2 diabetes mellitus. However, the inclusion of serum ferritin levels in the final multivariate model attenuated the odds ratio only slightly, from 3.77 (CI, 1.80 to 7.87) to 3.28 (CI, 1.80 to 5.99). Thus, to the extent that serum ferritin, an acute-phase reactant that may be affected by inflammation, reflects hepatic iron stores, iron overload does not seem to fully explain the increased occurrence of type 2 diabetes mellitus among HCV-infected persons in NHANES III.
Shruti H. Mehta, MPH
Mark S. Sulkowski, MD
David L. Thomas, MD, MPH
Johns Hopkins University School of Public Health; Baltimore, MD 21201
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
