Clinical and Metabolic Effectiveness of Hypoglycemic Therapy in Patients with Type 2 Diabetes Mellitus Associated with Chronic Hepatitis C Infection

Abstract

Type 2 diabetes mellitus (T2DM) and chronic hepatitis C virus (HCV) infection remain among the leading global medical and social health challenges due to their increasing prevalence, chronic progressive course, and high risk of disability and mortality. Numerous studies have demonstrated a close pathogenetic relationship between chronic hepatitis C and disturbances in carbohydrate metabolism, particularly insulin resistance and impaired glucose tolerance. In patients with chronic HCV infection, metabolic abnormalities may significantly affect the clinical course of both liver disease and diabetes mellitus. Objective to evaluate the clinical and metabolic effectiveness of various hypoglycemic therapy regimens in patients with type 2 diabetes mellitus associated with chronic hepatitis C infection. The study included 85 patients diagnosed with T2DM and chronic hepatitis C who underwent inpatient treatment at the multidisciplinary clinic of Tashkent State Medical University and the Research Institute of Virology. Patients were divided into four groups according to the administered glucose-lowering therapy: 1. Metformin monotherapy (n=28); 2. Sulfonylurea combined with metformin (n=24); 3. DPP-4 inhibitors combined with metformin (n=18); 4. Insulin therapy (n=15).  Clinical examination, anthropometric assessment, fasting plasma glucose, glycated hemoglobin (HbA1c), HOMA-IR index, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin levels were evaluated before and after 12 weeks of therapy. Statistical analysis was performed using SPSS 18.0 software. Differences were considered statistically significant at p<0.05. Patients receiving DPP-4 inhibitors in combination with metformin demonstrated significantly better glycemic control and improved liver biochemical parameters compared with other therapeutic groups. In this cohort, fasting glycemia and HbA1c levels decreased more substantially after 12 weeks of treatment. ALT levels decreased from 54.2±3.1 U/L to 44.2±2.1 U/L, while AST values decreased from 42.6±3.6 U/L to 37.6±1.6 U/L (p<0.05). In contrast, patients receiving insulin therapy showed persistently elevated metabolic and hepatic parameters, which may be associated with longer disease duration and more severe metabolic disturbances. Combined therapy with DPP-4 inhibitors and metformin demonstrated the highest therapeutic effectiveness in patients with T2DM associated with chronic hepatitis C infection. This treatment strategy contributed to improved carbohydrate metabolism, reduction of insulin resistance, and normalization of liver enzyme activity.