Impact of Direct-acting Antiviral Agents on Glycometabolism in Chronic
Hepatitis C Patients with Type 2 Diabetes Mellitus: A Systematic Review
and Meta-analysis
Abstract
Background and aims: The type 2 diabetes mellitus (T2DM) is a
common comorbidity of chronic hepatitis C (CHC). This study intended to
investigate the impact of direct-acting antiviral agents (DAAs)-induced
sustained virological response (SVR) on glycometabolism in CHC patients
with T2DM. Methods: We searched PubMed, Scopus, Web of Science,
and Embase up to July 7th, 2021. Studies reporting the association
between DAA-induced SVR and glycometabolism in diabetic patients were
retained. Changes in glycated hemoglobin (HbA1c) and fasting plasma
glucose (FPG) levels before DAA treatment and after SVR were conducted
meta-analyses with random-effects models. Results: 1371
potentially relevant articles were screened. Our analysis included 16
studies with data for 5024 patients. A significant improvement was noted
in glycemic control in SVR group, with a mean HbA1c reduction of 0.57%
(95% CI: 0.46–0.69%; I2=72.8%) and FPG reduction
of 22.28mg/dL (95% CI: 13.35–31.21mg/dL;
I2=96.18%). Conversely, changes of HbA1c in non-SVR
group were a mean increase of 0.03% (95% CI: -0.15–0.22%;
I2=68.75%). Subgroup analyses about HbA1c and FPG
classified by study type both showed decline of the two indicators after
SVR, and especially a reduction of HbA1c, 0.52% (95% CI: 0.39–0.65%;
I2=73.5%) in retrospective study subgroup and 0.70%
(95% CI: 0.54–0.87%; I2=36.15%) in prospective
study subgroup, indicating lower heterogeneity in prospective studies.
Egger’s test suggested publication bias in impact of DAAs on FPG, and no
publication bias in impact on HbA1c. Sensitivity analyses confirmed
robustness of the results. Conclusion: The glyco-metabolic
control improved in terms of HbA1c and FPG level after DAA-induced SVR.
However, further large and well-designed prospective cohort studies are
still warranted and a prolonged follow-up is needed.