Type II DM & HCV infection (relation and management)
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Transcript of Type II DM & HCV infection (relation and management)
TYPE II DM & HCV
By
Sayed Ahmed Hanzal
Ass, lecturer of Hepato-gastroenterology and tropical medicine
2015
DM
Chronic impairment of glucose metabolism&
the resultant hyperglycemia leads to multiple
organ damage
Caused by insuline (deficiency , resistance or
both)
About 6% of worlds adults are diabetic
About 90% of DM patients are type 2
HCV
Hepatitis C virus (HCV) infection is a major
cause of chronic liver disease, affecting ∼3% of
the world’s population
HCV & DM
Several studies have found a higher prevalence of HCV antibodies in type 2
diabetic patients than expected in the
general population .
HCV & DM
those with HCV infection were more than three times more likely than those without HCV
infection to have type 2 diabetes An increased prevalence of diabetes among
HCV-infected patients with chronic hepatitis
compared with either subjects with other chronic liver disease or the general population has been consistently reported
normal IGT DM
fasting 70---- 110-------126
On 2
occasions
2HPP 140 -------200
HGB A1c 5.7--------6.4
Random
BS
>200 with symptoms
WHAT ABOUT OTHER DRUGS….??
Medical therapy for patients with type 2 diabetes and liver disease may be the same for patients without liver
disease.
Metformin is first-line therapy for T2DM in
patients with a body mass index > 25
kg/m2.
Insulin secretagogues (eg, gliclazide and
repaglinide) are the second-line therapy
for patients with T2DM. Because they are
metabolized by the liver, their duration of
action may be prolonged in patients with
CLD. Therefore, they should be avoided or
used with caution at low doses in patients
with T2DM and CLD.
SUMMERY An increase of the fasting insulin and a
decrease in insulin sensitivity have been
observed in HCV-infected subjects with a
moderate or severe degree of hepatic fibrosis .
data suggest that HCV is capable of producing
an increase in insulin resistance, even before a
minimal degree of hepatic fibrosis is present
also
both insulin resistance and diabetes can
adversely affect the course of chronic hepatitis
C leading to enhanced steatosis and liver
fibrosis and even increase the risk of
hepatocellular carcinoma