Prevalence of hepatitis C infection in patients with type 2 diabetes mellitus

BACKGROUND: Recently, a possible epidemiological association between hepatitis C virus infection and diabetes mellitus has been suggested and a higher prevalence of HCV antibodies has been found among type 2 diabetic when compared with normal controls. AIM: To evaluate the prevalence of hepatitis C infection in diabetic patients in Curitiba, PR, Brazil. PATIENTS AND METHODS: A total of 145 type 2 and 104 type 1 diabetic patients attending the outpatient diabetic unit of an university hospital were consecutively tested for anti-HCV, using a fourth-generation enzyme-linked immunosorbent assay (ELISA). The control group was constituted by 16,720 volunteer blood donors attending the blood bank of the same hospital during the period of the study. Diabetic patients were also evaluated for clinical, biochemical (aminotransferase levels) and demographic variables and previous exposure to risk factors for hepatitis C infection. RESULTS: A higher prevalence of hepatitis C infection was observed in type 2 diabetic patients in comparison with blood donors. Although anti-HCV prevalence in type 2 diabetic patients was higher than found in type 1, it did not reach statistical significance. Both diabetic groups were predominantly female, and as expected, type 2 diabetic were older than type 1. Race distribution, duration of the disease, and previous exposure to hepatitis C risk factors were similar in both groups, but type 2 diabetic subjects had higher median levels of alanine aminotransferase than type 1. CONCLUSIONS: A higher prevalence of hepatitis C infection was detected in type 2 diabetic patients in comparison with blood donors in our region, in accordance with study data from different populations. If all type 2 diabetic patients should undergo regular screening for hepatitis C infection remains a question.     

Prevalence of hepatitis C infection and risk factors in hospitalized diabetic patients: results of a cross-sectional study

OBJECTIVES: Although there may exist a nosocomial risk of hepatitis C virus (HCV) infection in patients with type 1 or type 2 diabetes, this risk has not been fully investigated thus far and its magnitude is unknown. The aim of this multicenter cross-sectional study was to evaluate the prevalence of, and risk factors for, hepatitis C infection in consecutive hospitalized patients with diabetes and to assess the nosocomial risk and magnitude of HCV infection in these patients. PATIENTS AND METHODS: Consecutive hospitalized patients with diabetes seen in 11 French hepatogastroenterology and diabetology departments were studied. The prevalence of anti-HCV antibodies was compared with that observed in healthy blood donors and individuals seen during routine medical checkup. Diabetic patients with anti-HCV antibodies were compared with patients without anti-HCV antibodies for assessment of risk factors. RESULTS: In total 1561 patients were studied. Independent risk factors for HCV infection were assessed through multivariate analysis. Thirty-three patients (2.11%) had anti-HCV antibodies and 21 (63.70%) had HCV identified risk factors. The prevalence of HCV infection was higher in patients with diabetes than in blood donors (0.08%) or healthy controls (0.20%) (P<0.001). Multivariate analysis identified four independent risk factors for HCV infection: blood transfusion before 1991 [odds ratio (OR)=2.88, P=0.033], intravenous drug use (OR=21.37, P=0.012), treatment in a hepatogastroenterology center (OR=4.17, P=0.002) and a high number (>2) of previous admissions since the onset of diabetes (OR=2.52, P=0.039). CONCLUSION: A nosocomial source of HCV infection in hospitalized diabetic patients is suggested by the increased risk of HCV infection associated with the number of hospitalizations. This may account for at least 36% of cases of HCV infection.     

Low prevalence of hepatitis C virus infection in Greek diabetic patients.

AIM: To assess the prevalence of hepatitis C virus (HCV) among Greek patients with Type 1 and 2 diabetes mellitus (DM), in view of the previous reports of high prevalence, particularly in patients with elevated aminotransferase. METHODS: We checked 423diabetic patients (183 male, 240 female, mean age: 63 years) attending our unit, recording epidemiology data, diabetes history, treatment and classification. Patients were stratified by aminotransferase values (normal or elevated). HCV screening was performed using standard techniques. Statistical analysis was done by using the Student's t-test for continuous variables and chi-square (chi2) for categorical data. RESULTS: Antibodies against HCV (anti-HCV) were detected in seven out of 423 diabetic patients (prevalence 1.65%). There was no correlation between HCV titre and diabetes type, duration, treatment, obesity (body mass index, BMI) or glycaemic control (HbA1c). The only correlation was elevated aminotransferase values (P<0.01) Among the established risk factors for HCV transmission, only history of previous transfusion was significant (P < 0.001). CONCLUSIONS: It remains a strong hypothesis that diabetic patients are at increased HCV infection risk, yet our findings in Greek diabetic patients were rather low. Further studies, possibly multicentre, are needed to estimate prevalence and address the question of whether a direct effect of HCV in diabetes development does actually exist.     

Diabetes in the elderly in a developing country.

In developing countries diabetes in the elderly is thought to be uncommon and is consequently ignored by health planners. We assessed the prevalence of complications of diabetes mellitus and frequency of hospital admissions in patients aged 60 and over in a hospital diabetic clinic in Sri Lanka. Elderly diabetic patients, though comprising only 23% of clinic patients, accounted for 46% of admissions. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease, hypertension and visual handicap was increased in the diabetic patients when compared to age and gender matched controls. We conclude that diabetes in the elderly is a significant cause of morbidity in Sri Lanka.     

Prevalence of hepatitis C virus seropositivity among hospitalized US veterans

BACKGROUND: Hepatitis C virus (HCV) is a major cause of acute and chronic hepatitis in the United States and abroad. HCV antibody prevalences ranging from 10 to 90% have been reported in intravenous drug abusers, hemodialysis patients, and persons suffering from other liver diseases, whereas HCV seropositivity rates for volunteer-blood donor populations are generally under 1%. However no information has been available concerning the prevalence of HCV in general hospital populations in the United States. METHODS: We examined the rate of HCV seropositivity in 530 patients admitted to the Atlanta VA Medical Center between November 1993 and November 1994. The test population consisted of 400 random hospital admissions, 100 successive admissions to the surgical service, and 30 random admissions to the gastrointestinal service. Serum samples were assayed for HCV antibodies by a second generation EIA, and all repeat reactives were re-examined using a supplemental research assay to confirm the presence of HCV antibodies. Complete chart reviews were carried out on all HCV seropositive patients and on 100 HCV seronegative patients. RESULTS: Sixty-two of the 530 patients tested (11.7%) were repeatedly positive for HCV antibodies. Of these 62 repeat reactives, 56 (90.3%) were positive and 3 others (4.8%) indeterminate by the supplemental assay. The HCV seropositivity rate after supplemental testing was 11.8% for random admissions, 5.0% for surgical admissions, and 13.3% for patients admitted to the gastroenterology service. HCV-associated risk factors in HCV seropositive patients included a history of intravenous drug abuse, current or previous alcohol abuse, previous or concurrent liver disease, previous blood transfusions, hemodialysis, and multiple sex partners or unsafe sex. CONCLUSIONS: HCV infection may be more prevalent among hospitalized VA patients (and among other US hospital populations) than previously expected.     

Influence of Morbidity and Health Care Structure on Hospitalization Among Adult Diabetic Patients

The aim of the study was to investigate the influence of outpatient care, overall hospital bed provision and the prevalence of diabetes on the hospital use by adult diabetic patients. Population based data were collected in Finland from a 3-year period. Hospital admissions, inpatient days, and mean length of stay due to diabetes were derived from the Hospital Discharge Register. Estimates of diabetes prevalence were derived from the Central Drug Register. Primary outpatient site, annual number of physician visits, and age at onset among diabetic patients were assessed by questionnaire. The unit of analysis was hospital district (n = 21) and all analyses refer to the 15–64 years age group. Linear regression models were used to explain discharge rates and inpatient days in the district. Large variations between hospital districts were observed in diabetes prevalence, discharge rates due to diabetes, and mean length of stay among diabetic patients. Prevalence of diabetes and overall supply of hospital beds in the district were not related to hospital use. Univariate analyses showed that the larger the proportion of diabetic patients primarily using a private practitioner, the lower the hospital use. In districts where early onset of diabetes was more common, the average number of inpatient days was significantly lower than in other districts. In stepwise regression analyses, early onset of diabetes was the only variable that entered the models. In the full model, 24.6 % of the variance in inpatient days and 16.1 % of the variance in discharge rates were explained. In conclusion, factors related to health care structure, provision of hospital beds or morbidity explain little of the regional variation in hospital use. The observed variations in hospital use probably depend mainly on local treatment policies and differences in clinical decision-making.     

中国2010--2012年丙型肝炎哨点5类监测人群HCV感染状况分析

目的了解丙型肝炎（丙肝）哨点5类监测人群（肾透析人群、无偿献血人群、医院侵入性诊疗人群、单位体检检群、计划生育门诊就诊人群）丙肝病毒（HCV）感染状况及趋势,为丙肝综合防治和科学干预提供信息和依据。方法2010-2012年,在每年46月,使用连续性监测方法收集5类监测人群的血样,完成HCV抗体的实验室检测,并进行描述和分析。结果20102012年,5类监测人群中,肾透析人群哨点HCV抗体阳性率（均数）均超过5％（0-25．3％）;医院侵入性诊疗人群HCV阳性率为0．7％～0．9％;除2010年无偿献血人群HCV抗体阳性率为0．6％外,其他年份单位体检人群、无偿献血人群、计划生育门诊就诊人群的HCV抗体阳性率均低于0．5％。结论肾透析人群的感染率持续处于较高水平,而其他丙肝哨点监测人群HCV抗体阳性率较低。血液传播是目前中国HCV传播的主要途径,如何避免或降低HCV传播的风险,是当前和今后应当重视和亟待解决的问题。     

Hepatitis C as a risk factor for diabetes type 2: lack of evidence in a hospital in central-west Brazil.

In order to assess the importance of HCV infection as a possible risk factor for type 2 diabetes mellitus, a case-control study was conducted, comparing the prevalence of HCV infection among diabetic and non-diabetic patients. Diabetic outpatients attending to a University Hospital in Central-West Brazil were evaluated between April and October 2005. A control group composed by patients from the same institution was matched by gender and age. Candidates to control group were included only if fasting glucose measures were under 100 mg/dL. Diabetics and controls had blood samples taken in order to test for antibodies against HCV (anti-HCV) by enzyme-immunoassay. Polymerase chain reaction and immunoblot were performed to confirm the anti-HCV status. Each group included 206 participants. Despite of the groups were in general comparable. The diabetics had a greater body mass average and smaller family income. The prevalence of confirmed anti-HCV in the diabetic group was of 1.4%, which was similar to the controls (1%). Finding statistical difference may have been hampered by the low frequency of HCV infection in both groups. It was not possible to demonstrate a role of HCV as an etiologic factor in type 2 diabetes, since HCV infected patients represented a small portion of the overall diabetes cases. This finding does not allow to recommend regular screening for HCV infection in type 2 diabetics in this region.     

The Potential Use of Radio Frequency Identification Devices for Active Monitoring of Blood Glucose Levels

Imagine a diabetes patient receiving a text message on his mobile phone warning him that his blood glucose level is too low or a patient''s mobile phone calling an emergency number when the patient goes into diabetic shock.Both scenarios depend on automatic, continuous monitoring of blood glucose levels and transmission of that information to a phone. The development of advanced biological sensors and integration with passive radio frequency identification technologies are the key to this. These hold the promise of being able to free patients from finger stick sampling or externally worn devices while providing continuous blood glucose monitoring that allows patients to manage their health more actively. To achieve this promise, however, a number of technical issues need to be addressed.     

Counting the Cost of Diabetic Hospital Admissions from a Multi-ethnic Population in Trinidad

Many middle-income countries are experiencing an increase in diabetes mellitus but patterns of morbidity and resource use from diabetes in developing countries have not been well described. We evaluated hospital admission with diabetes among different ethnic groups in Trinidad. We compiled a register of all patients with diabetes admitted to adult medical, general surgical, and ophthalmology wards at Port of Spain Hospital, Trinidad. During 26 weeks, 1447 patients with diabetes had 1722 admissions. Annual admission rates, standardized to the World Population, for the catchment population aged 30–64 years were 1031 (95% CI 928 to 1134) per 100 000 in men and 1354 (1240 to 1468) per 100 000 in women. Compared with the total population, admission rates were 33% higher in the Indian origin population and 47% lower in those of mixed ethnicity. The age-standardized rate of amputation with diabetes in the general population aged 30–64 years was 54 (37 to 71) per 100 000. The hospital admission fatality rate was 8.9% (95% CI 7.6% to 10.2%). Mortality was associated with increasing age, admission with hyperglycaemia, elevated serum creatinine, cardiac failure or stroke and with lower-limb amputation during admission. Diabetes accounted for 13.6% of hospital admissions and 23% of hospital bed occupancy. Admissions associated with disorders of blood glucose control or foot problems accounted for 52% of diabetic hospital bed occupancy. The annual cost of admissions with diabetes was conservatively estimated at TT$ 10.66 million (UK£1.24 million). In this community diabetes admission rates were high and varied according to the prevalence of diabetes. Admissions, fatalities and resource use were associated with acute and chronic complications of diabetes. Investing in better quality preventive clinical care for diabetes might provide an economically advantageous policy for countries like Trinidad and Tobago.     

Intravenous Drug Abuse–the Major Route of Hepatitis C Virus Transmission among Alcohol-Dependent Individuals?

As the prevalence of hepatitis C virus (HCV) antibodies has been reported to be high among alcohol-dependent individuals, we screened prospectively 310 consecutive non-selected alcoholic outpatients for HCV and possible routes of transmission. Using a second-generation enzyme-linked immunosorbent assay test and retesting all positive sera with a second-generation recombinant immunoblot assay, we found the prevalence of anti-HCV to be 14.5% (45 of 310). Of the 45 anti-HCV-positive individuals, 39 (88.7%) had a history of intravenous drug abuse, 2 had received blood transfusions, and only 4 lacked an identifiable source of infection. The magnitude of alcohol consumption, number of hospital admissions, duration of alcohol dependence, or presence of tattooing could not be shown to be factors of importance for the transmission of HCV infection. Our results suggest that a history of intravenous drug abuse is a common phenomenon and the predominant route of HCV transmission among alcoholics. True community-acquired infection would appear to be rare.     

Management of diabetes in French prisons: a cross-sectional study.

AIMS: To assess by a survey the management of prisoners with diabetes treated with insulin in French prisons. METHODS: A questionnaire was sent to the head of healthcare services for prisoners of every French prison. Information was obtained on prevalence of insulin-treated diabetes prisoners and diabetes care in prison. The number of episides of ketoacidosis and hypoglycaemia needing hospital admissions were evaluated during the past year. RESULTS: Among the 163 questionnaires sent, 115 were returned, giving an overall response rate of 69%. At the time of the study the prison population was 38 175 people. One hundred and sixty-nine prisoners were treated by insulin (0.4%). Self-monitoring of blood glucose was available only for 94 (55.6%) insulin-treated prisoners. A total of 130 (76.9%) prisoners performed two insulin injections daily or less, 105 (62.1%) prisoners were not allowed to keep their insulin delivery systems with them. Of the prisoners who treated themselves, 14 (12.1%) used syringes and 42 (36.5%) used pen devices. Ninety-two (55.1%) prisoners had had access to a diabetes specialist during the previous year. Diabetic diets were available in only 65 (60.7%) prisons. From June 1998 to June 1999, there were 20 hospital admissions for a diabetic ketoacidosis and 14 for hypoglycaemia. CONCLUSIONS: This study shows that prison decreases the autonomy of diabetic prisoners who often cannot self-inject or test their blood. Access to visiting consultant diabetologists and specialist nurses to educate both prisoners with diabetes and prison staff could improve diabetic care.     

Association of hepatitis C virus infection and diabetes

Epidemiologic studies have suggested a relation between hepatitis C virus (HCV) infection and diabetes mellitus. HCV infection is emerging as a metabolic disease, and diabetes mellitus as a risk factor for HCV infection. However, some data on the prevalence of antibodies to HCV in patients with diabetes are conflicting. These seroprevalence data should be interpreted with caution. Some potential bias may occur in those clinic-based studies that target a specific disease group. In this letter we explain some reasons for these conflicting studies.     

Hepatitis C-related cirrhosis: a predictor of diabetes after liver transplantation

Hepatitis C virus (HCV) infection has recently been suggested to be a risk factor for the development of diabetes mellitus. The aim of our study was to investigate whether the prevalence of diabetes is increased among liver transplant recipients infected with HCV. We compared the prevalence of diabetes among 278 liver transplant recipients whose original cause of liver failure was HCV infection (110 patients), hepatitis B virus infection (HBV; 53 patients), and cholestatic liver disease (CLD; 115 patients). The pretransplantation prevalence of diabetes was higher in the HCV group (29%) compared with the HBV (6%) and CLD (4%) groups (P <.001). The prevalence of diabetes remained higher in the HCV group 1 year after transplantation: 37%, 10%, and 5% in the HCV, HBV, and CLD groups, respectively (P <.001). The cumulative steroid dose during the first year of transplantation was significantly lower in the HCV group compared with the CLD group. Multivariate analysis revealed that HCV-related liver failure (P =.002), pretransplantation diabetes (P <.0001), and male sex (P =.019) were independent predictors of the presence of diabetes 1 year after transplantation. The high prevalence of diabetes persisted in the HCV group, with 41% diabetic at 5 years. The majority of patients with diabetes mellitus (89%) required insulin therapy after transplantation. Patient and graft survival rates were similar among patients with and without diabetes. In conclusion, our study shows that there is a high prevalence of diabetes among liver transplant recipients infected with HCV both before and after transplantation.     

Association of hepatitis C virus infection and diabetes

Epidemiologic studies have suggested a relation between hepatitis C virus (HCV) infection and diabetes mellitus. HCV infection is emerging as a metabolic disease, and diabetes mellitus as a risk factor for HCV infection. However, some data on the prevalence of antibodies to HCV in patients with diabetes are conflicting. These seroprevalence data should be interpreted with caution. Some potential bias may occur in those clinic-based studies that target a specific disease group. In this letter we explain some reasons for these conflicting studies.     

Challenge of hepatitis C in Egypt and hepatitis B in Mauritania

Egypt has one of the highest prevalence rates of hepatitis C virus(HCV) in the world,mostly with genotype 4 that is highly associated with severe fibrosis. As a consequence,hepatocellular carcinoma has become the leading cause of cancer in this country. Mauritania is a highly endemic area for hepatitis B virus(HBV). HBV and HCV could both be iatrogenically transmitted through infected blood products,infected needles,and medical equipment improperly sterilized. Adequate and efficient healthcare and public health measures with good surveillance programs,access for screening,prevention strategies,and successful treatment are needed to halt the spread of these diseases. Herein,we have reviewed the epidemiology,modes of transmission,predisposing factors,and novel treatment modalities of these viruses. We have proposed practices and interventions to decrease the risk of transmission of HCV and HBV in the affected countries,including strict adherence to standard precautions in the healthcare setting,rigorous education and training of patients and healthcare providers,universal screening of blood donors,use of safetyengineered devices,proper sterilization of medical equipment,hepatitis B vaccination,as well as effective direct-acting antiviral agents for the treatment of HCV.     

Hepatitis C virus infection in patients with nonalcoholic chronic liver disease

STUDY OBJECTIVE: To determine the prevalence and meaning of antibodies to the hepatitis C virus (HCV) in patients with nonalcoholic chronic liver diseases. DESIGN: Cross-sectional study. SETTING: The liver unit of a referral-based university hospital. PATIENTS: Three hundred and forty-six consecutive patients, including 137 with cryptogenic chronic liver disease, 156 with chronic hepatitis B, 47 with primary biliary cirrhosis, and 8 with persistently abnormal aminotransferase serum levels and normal liver histology. Among patients with cryptogenic liver disease, 41 received blood transfusions before discovery of liver disease and 18 had circulating nonorgan-specific autoantibodies. For comparison, 1495 apparently healthy volunteer blood donors were included in the study. LABORATORY INVESTIGATIONS: The presence of anti-HCV antibodies (anti-HCV) was determined by a recently developed enzyme-linked immunoassay. MEASUREMENTS AND MAIN RESULTS: In patients with cryptogenic liver disease, the prevalence of anti-HCV was 82% (95% CI, 76% to 89%), being higher (P = 0.02) in patients with histories of blood transfusion than in those with unknown sources of exposure. Antibodies to HCV were not detected in patients with antinuclear antibodies at high titer. Among patients with chronic hepatitis B, anti-HCV were found in 11% (CI, 5% to 18%) of those with hepatitis B virus (HBV)-associated DNA in serum and in 29% (CI, 17% to 43%) of those with undetectable HBV replication (P less than 0.05). The prevalence of anti-HCV in blood donors was 1.2% (CI, 1.1% to 1.3%). CONCLUSIONS: Our results indicate that HCV infection probably plays an important etiologic role in cryptogenic liver disease and, in some patients, in chronic hepatitis B. Determining whether anti-HCV are present appears to be useful for differentiating viral from autoimmune chronic liver diseases.     

The epidemiology of hepatitis C virus infection

The prevalence of hepatitis C virus (HCV) infection varies in different populations, ranging from as low as 0.6% in volunteer blood donors to as high as 80% in injection drug users. The prevalence of HCV in a population can be predicted by risk factors associated with the transmission of infection. These risk factors include injection drug use, blood product transfusion, organ transplantation, hemodialysis, occupational injury, sexual transmission, and vertical transmission. We review the literature regarding the incidence and prevalence of HCV infection and the evidence supporting various modes of HCV transmission.     

Association of hepatitis C virus infection and diabetes in central Tunisia

AIM：To investigate hepatitis C virus （HCV） seroprevalence in Tunisian patients with diabetes mellitus and in a control group. METHODS： A cross-sectional study was conducted to determine the HCV seroprevalence in 1269 patients with diabetes （452 male, 817 female） and 1315 nondiabetic patients, attending health centers in Sousse, Tunisia. HCV screening was performed in both groups using a fourth-generation enzyme immunoassay. RESULTS： In the diabetic group, 17 （1.3%） were found to be HCV-infected compared with eight （0.6%） in the control group, although the difference was not significant （P = 0.057）. Quantitative PCR was performed in 20 patients. Eleven patients were positive and showed HCV genotype lb in all cases. CONCLUSION： Frequency of HCV antibodies was low in patients with diabetes and in the control group in central Tunisia, with no significant difference between the groups.     

Prevalence of diabetes mellitus in China.

PURPOSE: To investigate the prevalence of diabetes mellitus in China. METHODS: The Beijing Eye Study 2006 is a population-based investigation including 3251 subjects aged 45+ years. Anthropometric measurements and blood biochemical analyses were performed for 2960 (91.0%) subjects. RESULTS: Defining diabetes mellitus as fasting glucose concentrations > or =7.0 mmol/L (detected in 227 subjects (prevalence rate: 7.67+/-0.49%)) or self-reported diagnosis of diabetes mellitus (154 subjects), 381 subjects were diabetic (prevalence rate: 12.87+/-0.62%). Within the diabetic group, 246 (64.6%) subjects were on diabetic diet or on additional anti-diabetic therapy, 205 (53.8%) subjects took oral anti-diabetic medication, and 44 (11.5%) subjects were on insulin therapy. Systemic complications due to diabetes mellitus were reported by 64 (16.8%) subjects. In multivariate analysis, diabetes mellitus was significantly associated with higher age, higher body mass index, higher systolic blood pressure, higher triglyceride concentrations, and lower high-density lipoprotein level. In addition, the diabetic subjects came significantly (P<0.001) more often from the urban region. CONCLUSIONS: This prevalence figure translates into more than 30 million diabetic individuals in China. Compared with previous studies, it suggests an increasing diabetes prevalence.