Table 1

Consequences of HCV-associated insulin resistance/diabetes

No. of patientsStudy design% IRHOMA-IROutcome measureResultReference
Hepatic fibrosis
121Retrospective case–controlNA>2Presence of advanced fibrosis

  • HCV-3 (OR 1.4, 95% CI 1 to 2; p=0.03)

  • Non-HCV-3 (OR 1.2. 95% CI 1.1 to 1.4; p=0.007)

56
528Presence of advanced fibrosis115
221ProspectiveNANAPresence of advanced fibrosisOR 1.57, 95% CI 1.04 to 2.39116
83Prospective–––x (p=0.0063)117
68Prospective longitudinal68%Fibrosis progressionHR 8.395, 95% CI (2.234 to 31.541)118
201 HCV-1Prospective, cross-sectional38% 14% (diabetic)HOMA-IR >2.7Presence of advanced fibrosis

  • IR (OR 2.692, 95% CI 1.463 to 4.954).

  • Diabetic vs non-diabetic with IR

  • 60 vs 30%, p=0.006

119
346 HCV-1 and HCV-3ProspectivexxPresence of advanced fibrosisHCV-1 (OR 3.22; p=0.02) HCV-3 (OR 3.17; p=0.04).120
226 HCV-4Prospective study46%HOMA-IR >3Presence of severe fibrosis

  • OR 3.864, 95% CI 1.859 to 8.034; p<0.001

121
170Prospective studyHOMA-IR >2Presence of severe fibrosisOR 2.44, 95% CI 1.15 to 5122
500Prospective study32.4%HOMA-IR >3Association between IR and liver fibrosis stageOR 1.803, 95% CI 1.155 to 2.815; p=0.00958
59Pilot open label studyMean HOMA 2.91Fibrosis progressionOne unit increase of HOMA was associated with increased fibrosis score 0.87% (95% CI 0.60% to 1.13%; p=001)123
Virological response
Rapid virological response131 (HCV-4)Prospective studyHOMA >2RVR, SVR

  • RVR (OR 0.12, 95% CI 72.2 to 194.76; p=0.002)

  • SVR 89% vs 41% (p=0.0001)

124
47 (HIV/HCV co-infection)Prospective studyHOMA >3RVR27 vs 73% (p=0.008)125
90 (HCV-1)RetrospectiveHOMA >2RVR, SVR

  • SVR 49% vs 39% (NS)

  • RVR (OR 0.14, 95% CI 0.03 to 065; p=0.013)

126
Sustained virological response
131 HCV-1ProspectiveHOMA >2SVR60% vs 32% (p=0.004)127
399 HCV-1Multicentre prospectiveHOMA >2SVR49% vs 36% (p=0.001)128
330 HCV-1 and HCV-2Open label retrospective29.1%HOMA >2.5SVR82.1% vs 68.8% (p=0.008)129
51 HCV-1RetrospectiveHOMA >2SVR65% vs 24% (p<0.001)130
133 HCV-1RetrospectiveHOMA >2SVR61% vs 42.4% (p=0.001)131
82 HCV-2 and HCV-3RetrospectiveHOMA >2SVR94 vs 65% (p<0.001)132
Hepatocellular carcinoma
68Prospective longitudinal68%Hepatoma-free survival10 years: 92.5% vs 100%
20 years: 66.4% vs 95.5%
30 years: 40.9% vs 81.6%		119
23820Prospective longitudinal1.5%Incidence of HCCRR of 60.3 (95% CI 23.6 to 153.6)133
541Retrospective16%Incidence of HCC

  • 13% vs 5.9%

  • 11.4% (95% CI 3.0 to 19.8) vs 5.0% (95% CI 2.2 to 7.8); p=0.013

134

  • Patients=2061

  • controls=6183

Population-based case–control study47%OR 36.88, 95% CI 2.64 to 3.40; p=0.0001135

  • Patients=823

  • controls=3459

Case–control study30.5%1.57 (95% CI 1.08 to 2.28; p=0.0176)136
279Prospective longitudinalIncidence of HCC137
5929Retrospective9.2%Incidence of HCCHR 3.1 (95% CI 1.7 to 5.4)138
197Retrospective11.7%Incidence of HCCHR 4.627, 95% CI 1.677 to 12.766139
Portal hypertension and OVs104Prospective study26%Prediction of the presence of OVsOR 1.296, 95% CI 1.018 to 1.649; p=0.03140
Transplant out comes
39Retrospective64% (PTDM)Mortality56% vs 14%, p=0.01141
95Retrospective50% metabolic syndromeFibrosis progression in recurrent HCV after OLT.OR=6.3; p=0.017.142
163RetrospectiveFibrosis progressionHR 2.68; p=0.039143
435Retrospective10.5% (PTDM)

  • Complications

  • Cardiac

  • Major infections

  • Neurological

  • Neuropsychiatric

  • Acute rejection

  • Survival

  • 48% vs 24%, p=0.005

  • 28% vs 5%, p=0.001

  • 22% vs 9%, p=0.05

  • 22 vs 6%, p=0.009

  • 50 vs 30%, p=0.03

  • Nodifference

144
16Prospective cohort study16% diabetic (23%: IR)(HOMA-IR >2.5)Fibrosis progressionHR 2.07, 95% CI 1.10 to 3.91145

  • HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HOMA, homeostatic model assessment; IR, insulin resistance; NA, not available; OLT, orthotopic liver transplantation; OVs, oesophageal varices; PTDM, post-transplant diabetes mellitus; RVR, rapid virological response; SVR, sustained virological response.