BACKGROUND & AIMS: Patients with chronic hepatitis C infection are 2-3-fold more likely to develop type-2 diabetes, which reduces their chances of achieving a sustained virologic response (SVR). To identify differences in predictors of SVR in patients with and without diabetes who received combination antiviral therapy, we conducted a retrospective analysis of national Veterans Affairs (VA) administrative database.
METHODS: We analyzed data from VA Medical SAS Datasets and Decision Support System for entire cohort and separately for diabetics (n=1704) and non-diabetics (n=6589). Significant predictors of SVR were identified by logistic regression analysis.
RESULTS: Diabetics had a lower SVR compared to non-diabetics (21% vs. 27%, p < 0.001). Diabetics had higher clustering of previously established negative predictors of SVR. On multivariate analysis of diabetics for SVR, the positive predictors were higher low density lipoprotein (OR=1.45, p=0.0129), use of statin (OR = 1.52, p = 0.0124) and lower baseline viral load (OR = 2.31, p < 0.001), while insulin therapy (0.7, p = 0.0278) was a negative predictor. Diabetics on statins had a higher pre-treatment viral loads (log 6.2vs.6.4, p= 0.006) but better early virologic response. There was a graded inverse relationship between HbA1c and SVR rate (p=0.0482). This relationship was highest among insulin users (p=0.0154) and lost among metformin users (p=0.5853).
CONCLUSIONS: Statin use was associated with an improved SVR among both diabetics and non-diabetics receiving combination antiviral therapy. Diabetics who received insulin achieved lower SVR compared to those not receiving insulin. Poor diabetes control was associated with lower SVR rates.