de Lucca SL, Narciso-Schiavon JL

Language: Spanish
References: 8
Page: 469-470
PDF size: 105.92 Kb.

Text Extraction

Dear editor:

We read with interest the recent study by Stine, et al.In the article, DAA therapy for chronic hepatitis C showed no effect on glycemic control of diabetic patients as assessed by HbA1c levels. Although the authors highlighted some limitations of the study in the discussion section, we would like to comment on HbA1c as a marker of glycemic control.
Several factors might result in falsely high or low HbA1c levels; some of those are common in patients with liver diseases. Falsely high HbA1c levels were related to severe hyperbilirubinemia and alcoholism.3 On the other hand, HbA1c values are decreased in patients with liver cirrhosis and are not an accurate parameter for glycemic control in those patients, especially in the setting of a more advanced liver disease. Cacciatore, et al. when comparing cirrhotics with nondiabetic subjects with chronic hepatitis without cirrhosis and healthy controls showed that HbA1c levels were not different between groups, even though glucose intolerance and diabetes were present 15% and 27% of the cirrhotics, respectively.

REFERENCES

1. Stine JG, Wynter JA, Niccum B, Kelly V, Caldwell SH, Shah NL. Effect of Treatment with Direct Acting Antiviral on Glycemic Control in Patients with Diabetes Mellitus and Chronic Hepatitis C. Ann Hepatol 2017; 16: 215-20.

2. Homa K, Majkowska L. Difficulties in interpreting HbA(1c) results. Pol Arch Med Wewn 2010; 120: 148-54.

3. Hoberman HD, Chiodo SM. Elevation of the hemoglobin A1 fraction in alcoholism. Alcohol Clin Exp Res 1982; 6: 260-6.

4. Elkrief L, Rautou PE, Sarin S, Valla D, Paradis V, Moreau R. Diabetes mellitus in patients with cirrhosis: clinical implications and management. Liver Int 2016; 36: 936-48.

5. Cacciatore L, Cozzolino G, Giardina MG, De Marco F, Sacca L, Esposito P, Francica G, et al. Abnormalities of glucose metabolism induced by liver cirrhosis and glycosylated hemoglobin levels in chronic liver disease. Diabetes Res 1988; 7: 185-8.

6. Nomura Y, Nanjo K, Miyano M, Kikuoka H, Kuriyama S, Maeda M, Miyamura K. Hemoglobin A1 in cirrhosis of the liver. Diabetes Res 1989; 11: 177-80.

7. Nadelson J, Satapathy SK, Nair S. Glycated Hemoglobin Levels in Patients with Decompensated Cirrhosis. Int J Endocrinol 2016; 2016: 8390210.

8. Gonzalez-Casas R, Jones EA, Moreno-Otero R. Spectrum of anemia associated with chronic liver disease. World J Gastroenterol 2009; 15: 4653-8.