Stine JG, Wynter JA, Niccum B, Kelly V, Caldwell SH, Shah NL

Language: English
References: 0
Page: 471-472
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To the Editor:

We appreciate the interest of Schiavon and colleague in our study investigating the impact of direct acting antiviral drugs on glycemic control in patients with diabetes mellitus and chronic hepatitis C virus (HCV) and we welcome the discussion about the limitations of hemoglobin A1c (HbA1c) testing in patients with cirrhosis. Accurate assessment of glycemic control in chronic liver disease is imperative given that glucose intolerance has been reported to be as high as 80% and that pre-liver transplantation alterations in glucose metabolism can persist long-term following transplantation.
We agree that HbA1c is an imperfect marker of glycemic control in any patient where shorter red blood cell (RBC) lifespan is observed. Cirrhosis patients are well described to have such conditions, namely related to portal hypertension with hypersplenism and blood loss due to acute gastroesophageal variceal hemorrhage or chronic occult blood loss due to portal hypertensive gastropathy. In addition, nutritional compromise and hemolytic anemia are also common in cirrhosis, effectively leading to shorter RBC lifespans.