Another component of diabetes risk reduction in patients with HCV is controlling hypertension.8 Of note, treatment with angiotensin-blocking agents has been associated with reduced liver fibrosis in HCV patients, compared with those receiving no antihypertensives or diuretics, vasodilators, or calcium channel antagonists.8,9
Patients with HCV who do develop diabetes are advised against using insulin or a sulfonylurea (ie, glipizide, glimepiride, glyburide).2 Metformin is considered a safer option, and its use has been linked to a reduced risk for HCC.2,10 Diabetic patients with HCV can also reduce their risk for HCC by maintaining an A1C level below 7.0%, according to Arase et al.5
REFERENCES
1. Serfaty L, Capteau J. Hepatitis C, insulin resistance and diabetes: clinical and pathogenic data. Liver Int. 2009;29(suppl 2):13-25.
2. Kawaguchi Y, Mazuta T. Interaction between hepatitis C virus and metabolic factors. World J Gasterentol. 2014;20(11):2888-2901.
3. US Department of Veterans Affairs. Viral hepatitis: diet and nutrition. http://www.hepatitis.va.gov/patient/daily/diet/single-page.asp. Accessed May 26, 2015.
4. Lonardo A, Loria P, Carulli N. Dysmetabolic changes associated with HCV: a distinct syndrome? Intern Emerg Med. 2008;3(2):99-108.
5. Arase Y, Kobayashi M, Suzuki F, et al. Effect of type 2 diabetes on risk for malignancies includes hepatocellular carcinoma in chronic hepatitis C. Hepatology. 2013;57(3):964-973.
6. Takahashi H, Mizuta T, Eguchi Y, et al. Post-challenge hyperglycemia is a significant risk factor for the development of hepatocellular carcinoma in patients with chronic hepatitis C. J Gastroenterol. 2011;46(6):790-798.
7. Rzouq F, Alahdab F, Olyaee M. Statins and hepatitis C virus infection: an old therapy with new scope. Am J Med Sci. 2014;348(5):426-430.
8. Arase Y, Suzuki F, Suzuki Y, et al. Losartan reduces the onset of type 2 diabetes in hypertensive Japanese patients with chronic hepatitis C. J Med Virol. 2009;81(9):1584-1590.
9. Corey KE, Shah N, Misdraji J, et al. The effect of angiotensin-blocking agents on liver fibrosis in patients with hepatitis C. Liver Int. 2009; 29(5):748-753.
10. Harris K, Smith L. Safety and efficacy of metformin in patients with type 2 diabetes mellitus and chronic hepatitis C. Ann Pharmacother. 2013;47(10):1348-1352.