1Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
BACKGROUND AND AIMS:
Early recognition of prediabetes can lead to timely clinical interventions to prevent type 2 diabetes. Both Latino ethnicity and chronic hepatitis C (HCV) have been identified as diabetic risk factors. We aimed to investigate predictors of impaired fasting glucose (IFG), a common prediabetic state, among Latinos with and without HCV.
One hundred Latino adults with no history of diabetes or cirrhosis underwent clinical, laboratory, and metabolic evaluation, including oral glucose tolerance testing (OGTT) and insulin suppression testing to quantify directly measured insulin resistance (IR). Isolated IFG was defined as fasting glucose ≥100mg/dL and <140mg/dL at 2 hours with normal glucose tolerance during OGTT.
Overall subject characteristics included median age 44 years, 64% male, 40% HCV-positive, and 32% with isolated IFG. Factors associated with isolated IFG included subject age (OR 2.42 per decade, 95%CI 1.40-3.90, p=0.001), HCV infection (OR 4.0, 95%CI 1.71-9.72, p=0.002), and alanine aminotransferase (ALT) (OR 2.35 per doubling, 95%CI 1.46-3.77, p<0.0001). Multipredictor logistic regression analysis identified ALT (OR 2.05 per doubling, p=0.005, 95% CI 1.24-3.40) and age (OR 2.20 per 10 years, p=0.005, 95%CI 1.27-3.80) as factors independently associated with IFG. While HCV was associated with 4-fold higher odds of IFG, this entire effect was mediated by ALT.
We found strong evidence that liver inflammation is a risk factor for prediabetes among Latinos with and without HCV. Among HCV-infected individuals, early antiviral therapy could mitigate the effect of inflammation and represent an important intervention to prevent diabetes in this at-risk population.