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World J Diabetes. Oct 15, 2014; 5(5): 586-600
Published online Oct 15, 2014. doi: 10.4239/wjd.v5.i5.586
Hepatitis C virus infection and type 1 and type 2 diabetes mellitus
Alessandro Antonelli, Silvia Martina Ferrari, Dilia Giuggioli, Andrea Di Domenicantonio, Ilaria Ruffilli, Alda Corrado, Silvia Fabiani, Santino Marchi, Clodoveo Ferri, Ele Ferrannini, Poupak Fallahi
Alessandro Antonelli, Silvia Martina Ferrari, Andrea Di Domenicantonio, Ilaria Ruffilli, Alda Corrado, Silvia Fabiani, Ele Ferrannini, Poupak Fallahi, Department of Clinical and Experimental Medicine, University of Pisa, I-56126 Pisa, Italy
Dilia Giuggioli, Clodoveo Ferri, Department of Medical, Surgical, Maternal, Pediatric and Adult Sciences, University of Modena and Reggio Emilia, I-41124 Modena, Italy
Santino Marchi, Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, I-56122 Pisa, Italy
Author contributions: Antonelli A and Ferri C designed the research; Ferrari SM, Giuggioli D, Di Domenicantonio A, Ruffilli I, Corrado A, Fabiani S and Fallahi P performed the research; Antonelli A, Marchi S, Ferri C and Ferrannini E analysed the data; Antonelli A, Ferrari SM, Fabiani S, Ferri C and Fallahi P wrote the paper.
Correspondence to: Alessandro Antonelli, MD, Professor, Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, 10, I-56126 Pisa, Italy. alessandro.antonelli@med.unipi.it
Telephone: +39-050-992318 Fax: +39-050-553235
Received: November 29, 2013
Revised: April 10, 2014
Accepted: July 12, 2014
Published online: October 15, 2014
Abstract

Hepatitis C virus (HCV) infection and diabetes mellitus are two major public health problems that cause devastating health and financial burdens worldwide. Diabetes can be classified into two major types: type 1 diabetes mellitus (T1DM) and T2DM. T2DM is a common endocrine disorder that encompasses multifactorial mechanisms, and T1DM is an immunologically mediated disease. Many epidemiological studies have shown an association between T2DM and chronic hepatitis C (CHC) infection. The processes through which CHC is associated with T2DM seem to involve direct viral effects, insulin resistance, proinflammatory cytokines, chemokines, and other immune-mediated mechanisms. Few data have been reported on the association of CHC and T1DM and reports on the potential association between T1DM and acute HCV infection are even rarer. A small number of studies indicate that interferon-α therapy can stimulate pancreatic autoimmunity and in certain cases lead to the development of T1DM. Diabetes and CHC have important interactions. Diabetic CHC patients have an increased risk of developing cirrhosis and hepatocellular carcinoma compared with non-diabetic CHC subjects. However, clinical trials on HCV-positive patients have reported improvements in glucose metabolism after antiviral treatment. Further studies are needed to improve prevention policies and to foster adequate and cost-effective programmes for the surveillance and treatment of diabetic CHC patients.

Keywords: Hepatitis C virus infection, Type 1 diabetes mellitus, Type 2 diabetes mellitus, Epidemiology, Pathogenesis, Prevention, Treatment

Core tip: Many studies have shown an association between type 2 diabetes mellitus (T2DM) and chronic hepatitis C (CHC) infection. The processes through which CHC is associated with T2DM seem to involve direct viral effects, insulin resistance, proinflammatory cytokines, and chemokines. Few data have been reported on the association of CHC and T1DM. A small number of studies indicate that interferon-α therapy can induce T1DM. Diabetic CHC patients have an increased risk of developing cirrhosis and hepatocellular carcinoma compared with non-diabetics. Clinical trials on hepatitis C virus-positive patients have reported improvements in glucose metabolism after antiviral treatment.