Frequency of Diabetes Mellitus in Patients with Chronic Hepatitis C Infection

Diabetes and hepatitis C infection are prevalent worldwide. The one chronic disease the later communicable disease is associated as far mortality is concern. People with hepatitis C infection are prone to develop type 2 diabetes. Objective: To �nd out the frequency of diabetes mellitus in chronic hepatitis C infected patients admitted to Department of Medicine, Khyber Teaching Hospital KPK . Methods: A cross-sectional Descriptive Study was conducted having 104 patients aged 15 years and above from both genders in department of Medicine for a duration nd th of one year from 2 March 2020 to 26 February 2021.The inclusion criteria were set for patients who were hepatitis C positive for at least two months investigated through detection of HCV antibodies by ELISA. Chronic hepatitis C was diagnosed on the basis of detecting HCV antibodies by ELISA, and con�rmed by detecting HCV RNA by polymerase chain reaction (PCR). Diabetes mellitus was diagnosed on the basis of random blood sugar above 200 mg/dL, fasting blood sugar above 126 mg/dL on two occasions or HBA1C above 6.5 % (diagnostic criteria designed by ADA). Results: Only 21 (21%) were found to have newly diagnosed diabetes mellitus with a p value 0.37. Those with impaired glucose levels were found in 15(15%), and 59(59%) were with normal glucose level. Conclusions: Our study did not �nd any statistical signi�cance in our result with p-value= (0.37).

in diabetic patients [6]. Many other studies have demonstrated a noteworthy association between diabetes mellitus type 2 and chronic hepatitis C infection which is minor with hepatitis B [7,8]. The incidence of DM type 2 in HCV patients mostly occurs in the absence of other predisposing factors; obesity, positive family history, poor diet control and lack of exercise. This may propose the direct role of hepatitis C in pathogenesis of diabetes mellitus [9]. Diabetes in chronic hepatitis C patients presents in a very peculiar manner, in which chronic degenerative changes in the liver gradually aid in the development of diabetes mellitus, thus acting as a precipitating factor [10]. Increased iron overload is also a Frequency of Diabetes with Hepatitis C

I N T R O D U C T I O N
Diabetes and hepatitis C infection are prevalent worldwide. The one chronic disease the later communicable disease is associated as far mortality is concern. People with hepatitis C infection are prone to develop type 2 diabetes. Objective: To nd out the frequency of diabetes mellitus in chronic hepatitis C infected patients admitted to Department of Medicine, Khyber Teaching Hospital KPK. Methods: A cross-sectional Descriptive Study was conducted having 104 patients aged 15 years and above from both genders in department of Medicine for a duration nd th of one year from 2 March 2020 to 26 February 2021.The inclusion criteria were set for patients who were hepatitis C positive for at least two months investigated through detection of HCV antibodies by ELISA. Chronic hepatitis C was diagnosed on the basis of detecting HCV antibodies by ELISA, and con rmed by detecting HCV RNA by polymerase chain reaction (PCR). Diabetes mellitus was diagnosed on the basis of random blood sugar above 200 mg/dL, fasting blood sugar above 126 mg/dL on two occasions or HBA1C above 6.5 % (diagnostic criteria designed by ADA). Results: Only 21 (21%) were found to have newly diagnosed diabetes mellitus with a p value 0.37. Those with impaired glucose levels were found in 15(15%), and 59(59%) were with normal glucose level. Conclusions: Our study did not nd any statistical signi cance in our result with p-value= (0.37).

A R T I C L E I N F O A B S T R A C T
Newly diagnosed diabetic individuals were 23 (21%) with chronic hepatitis C, impaired glucose levels were found in 17(15%), and 64(59%) were with normal glucose level. pvalue (p= 0.37) table 2. No HCV RNA was detected in 5 (5%) patients with chronic hepatitis, 1(1 %) of which were non diabetic, 3 (3 %) had impaired glucose tolerance and 1% had DM. p-value of our result was 0.37 which did not show any statistical signi cance in our results. common nding in chronic hepatitis which is also an important risk factor for development of DM type 2. Given the postulate that HCV by itself induces insulin resistance, a logical hypothesis is that viral eradication should be associated with reduction in insulin resistance. Globally, the trends in HCV are rising among both developing and developed world. This increase in burden of HCV leaves behind the epidemic of diabetes and vice versa that requires further studies. As diabetes is considered rapidly becoming a major public health problem. This is of immense importance to check the rising trends and epidemiology (Descriptive as well as Analytical) of diabetes in various sections of populations. Not enough studies have been done previously on epidemiology of diabetes and its association with chronic hepatitis C patients, especially in this part of the world.

R E S U L T S
Chronic hepatitis C infection and diabetes mellitus are the

M E T H O D S
A cross-sectional descriptive study was conducted having 104 patients aged 15 years and above from both genders in nd Department of Medicine for a duration of one year from 2 th March 2020 to 26 Feburuary2021. Chronic hepatitis C was diagnosed on the basis of detecting HCV antibodies by ELISA, and con rmed by detecting HCV RNA by polymerase chain reaction (PCR). Diabetes mellitus was diagnosed on the basis of random blood sugar above 200 mg/dL, fasting blood sugar above 126 mg/dL on two occasions or HBA1C above 6.5 % (diagnostic criteria designed by ADA) The demographic data were collected in the form of information on a preplanned questionnaire mentioning required details regarding name, age, gender, location, family history of the disease, other related diseases and previous treatments taken for hepatitis C. Data were analyzed using Statistical Package for the Social Sciences (SPSS for Windows, release 22.0; SPSS, Inc., Chicago, IL, USA. A total of 104 patients were included and investigated in this study after taking informed consent. Mean age of the patients' understudy was 54.38 ± 15.81. Male were more 68% as compared to female Table 1.  Prevalence of diabetes among chronic hepatitis C patients were observed more among males 62% as compared to females 38% (Figure 1).  Figure 1: Frequency of diabetes among chronic hepatitis C patients in Gender A little above 30 patients, aged above 45 years with HbA1c below 6.5 had portal hypertension. In the same age group, but with HbA1c above 6.5, less than 20 patients had portal hypertension. Portal hypertension was not seen in less than 5 patients who had uncontrolled DM and in around 10 patients with controlled DM table 3. This again con rms that patients with chronic HCV had portal hypertension regardless of whether their DM was under control or not. It is evident that liver parenchymal damage and portal hypertension are both associated with increase in age but independent of DM in HCV patients (Table 3).  We also concluded that liver parenchymal damage and portal hypertension are both associated with increase in age in chronic HCV patients. However, it is completely independent of diabetes mellitus in chronic HCV patients. m a j o r p u b l i c h e a l t h p ro b l e m s wo r l d w i d e. M a ny epidemiological studies have demonstrated signi cant association between chronic hepatitis C and diabetes mellitus. A prospective study on 404 patients was conducted in Korea like our study. As contrast to our study, diabetes was observed more frequently in chronic hepatitis C (24%) than those with HBV, which we did not take account of in our study, furthermore, sample size was larger (10.4%) (p= <0.05) in comparison to our sample size (21%) (P=0.37). However, similar to our study, they have found higher association of DM with increase in age of 40-60 (p=0.005) [11][12]. A study conducted in Southeast Asia with a sample size of 361, in contrast to our sample size of 100, prevalence of diabetes mellitus was 31.5% as compared to 21%. Out of these, 58.2% (n=211) participants were cirrhotic while 46.6% were non-cirrhotic (n=150). Diabetes was signi cantly associated to cirrhosis (p=0.01) compared to (p=0.37) in our study [13]. Similarly, in China, a study of 359 cases with a mean age of 58, like our study had impaired glucose control of 34.6% which is higher than our study (22%) but their study had taken into account the family history of diabetes, as opposed to our study [14][15][16].
A large population-based study was conducted in Southern Taiwan with a population size of 180,359 in contrast to our sample size (100) but with a similar mean of age. In this study, 13428 HCV positive patients showed positive association with metabolic syndrome and diabetes mellitus, in contrast to our study. [17]. Another study conducted in 2006 showed similar results to ours. The study population consisted of 180 HCV positive patients. The prevalence of T2DM was 38% in contrast to 21% in our study. There was no signi cant association of diabetes mellitus in chronic hepatitis C [18]. Another study conducted in Egypt with a sample size of 591 HCV positive patients showed that 150 (25.4%) of them had diabetes mellitus with a p value (p=0.0001) as compared to (p=0.37) in our study. Again, the sample size was greater than ours but the association between the degree of liver disease and development of diabetes mellitus did not differ statistically between the two studies [19,20]. A similar study conducted in New Orleans; USA performed a retrospective analysis in contrast to our cross sectional with a sample of 9,783 patients. HCV, chronic hepatitis and cirrhosis were independently associated with the development of diabetes mellitus with a prevalence of (21%) and (p=0.004) as compared to (21%) of our study with (p=0.37) [21]. The higher diabetes frequency among chronic hepatitis c patients need diabetologist input as far management is concern.
C O N C L U S I O N S  S o u r c e o f F u n d i n g The authors received no nancial support for the research, authorship and/or publication of this article.

R E F E R E N C E S
[1] [2] All authors have read and agreed to the published version of the manuscript. [3] [4] [5] [6]