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Vol. 14, No. 4, 2005
Issue release date: July–August 2005
Section title: Case Report
Open Access Gateway
Med Princ Pract 2005;14:281–283
(DOI:10.1159/000085751)

Late Development of Diabetes mellitus after Interferon-Alfa and Ribavirin Therapy for Chronic Hepatitis C: A Case Report

Radhakrishnan S.a · Upadhyay A.a · Mohan N.a · Dhar A.a · Walia H.a · Zubaidi G.b
Departments of aGastroenterology and bEndocrinology, The Royal Hospital, Muscat, Oman
email Corresponding Author

Abstract

Objective: To report the late development of immune-mediated diabetes mellitus after completion of alfa-interferon therapy for hepatitis C in an Asian patient. Clinical Presentation and Intervention: A 50-year-old male with chronic hepatitis C received treatment with alfa-interferon and ribavirin for 52 weeks. He developed immune-mediated diabetes mellitus with low C-peptide and positive antiglutamic acid decarboxylase antibody after completion of therapy. The hepatitis C infection was eradicated, but he continued to be diabetic requiring insulin therapy during the follow-up. Conclusion: This report shows thatimmune-mediateddiabetes mellitus can occur as a late complication of alfa-interferon therapy.

© 2005 S. Karger AG, Basel


  

Key Words

  • Hepatitis C
  • Alfa-interferon
  • Immune-mediated diabetes mellitus

References

  1. Cohen J: The scientific challenge of hepatitis C. Science 1999;285:26–30.
  2. Allison MED, Wreghitt T, Palmer CR, Alexander GJM: Evidence of a link between hepatitis C virus infection and diabetes mellitus in a cirrhotic population. J Hepatol 1994;21:1135–1139.
  3. Caronia S, Taylor K, Pagliaro L, Carr C, Palazzo U, Petrik J, et al: Further evidence for an association between non-insulin dependent diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999;30:1059–1063.
  4. Mehta SH, Brancati GL, Sulkowski MS, Strathdee SA, Szklo M, Thomas DL: Prevalence of type-2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000;133:592–599.
  5. Fabris P, Betterle C, Greggio NA, Zanchetta R, Bosi E, Biasin MR, et al: Insulin-dependent diabetes mellitus during alfa-interferon therapy for chronic viral hepatitis. J Hepatol 1998;28:514–517.
  6. Uto H, Matsuoka H, Murata M, Okamoto T, Miyata Y, Hori T, et al: A case of chronic hepatitis C developing insulin-dependent diabetes mellitus associated with various autoantibodies during interferon therapy. Diabetes Res Clin Pract 2000;49:101–106.
  7. Recasens M, Aguilera E, Ampurdanes S, Sanches Tapias JM, Simo O, Casamitjana R, et al: Abrupt onset of diabetes during interferon-alpha therapy in patients with chronic hepatitis C. Diabet Med 2001;18:764–767.
  8. Eibl N, Gschwantler, Ferenci P, Eibl MM, Weiss W, Schernthaner G: Development of insulin-dependent diabetes mellitus in a patient with chronic hepatitis C during therapy with interferon-alpha. Eur J Gastroenterol Hepatol 2001;13:295–298.
  9. Wasmuth HE, Stolte C, Geier A, Gartung C, Matern S: Induction of multiple autoantibodies to islet cell antigens during treatment with interferon alfa for chronic hepatitis C. Gut 2001;49:596–597.
  10. Dicesare E: Interferon-alpha therapy may induce insulin autoantibody development in patients with chronic viral hepatitis. Dig Dis Sci 1996;41:1672–1677.
  11. McLaren NK, Lan M, Coutant R, et al: Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2 and IA-2 predict immune-mediated (type-I) diabetes in relatives. J Autoimmun 1999;12:279–287.
  12. Bhatti A, McGarrity TJ, Gabbay R: Diabetic ketoacidosis induced by alfa interferon and ribavirin treatment in a patient with hepatitis C. Am J Gastroenterol 2001;96:604–605.

  

Author Contacts

Dr. S. Radhakrishnan, FRCP (Edin)
Gastroenterology Division
The Royal Hospital, PO Box 1331, CPO 111
Muscat (Oman)
Tel./Fax +968 594461, E-Mail jagan01@omantel.net.om

  

Article Information

Received: October 21, 2003
Revised: June 2, 2004
Number of Print Pages : 3
Number of Figures : 0, Number of Tables : 0, Number of References : 12

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 14, No. 4, Year 2005 (Cover Date: July-August 2005)

Journal Editor: Al Awadi, F. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/mpp


Open Access License / Drug Dosage / Disclaimer

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Objective: To report the late development of immune-mediated diabetes mellitus after completion of alfa-interferon therapy for hepatitis C in an Asian patient. Clinical Presentation and Intervention: A 50-year-old male with chronic hepatitis C received treatment with alfa-interferon and ribavirin for 52 weeks. He developed immune-mediated diabetes mellitus with low C-peptide and positive antiglutamic acid decarboxylase antibody after completion of therapy. The hepatitis C infection was eradicated, but he continued to be diabetic requiring insulin therapy during the follow-up. Conclusion: This report shows thatimmune-mediateddiabetes mellitus can occur as a late complication of alfa-interferon therapy.

© 2005 S. Karger AG, Basel


  

Author Contacts

Dr. S. Radhakrishnan, FRCP (Edin)
Gastroenterology Division
The Royal Hospital, PO Box 1331, CPO 111
Muscat (Oman)
Tel./Fax +968 594461, E-Mail jagan01@omantel.net.om

  

Article Information

Received: October 21, 2003
Revised: June 2, 2004
Number of Print Pages : 3
Number of Figures : 0, Number of Tables : 0, Number of References : 12

  

Publication Details

Medical Principles and Practice (International Journal of the Kuwait University Health Sciences Centre)

Vol. 14, No. 4, Year 2005 (Cover Date: July-August 2005)

Journal Editor: Al Awadi, F. (Kuwait)
ISSN: 1011–7571 (print), 1423–0151 (Online)

For additional information: http://www.karger.com/mpp


Article / Publication Details

First-Page Preview
Abstract of Case Report

Received: 10/21/2003
Accepted: 6/2/2004
Published online: 6/13/2005
Issue release date: July–August 2005

Number of Print Pages: 3
Number of Figures: 0
Number of Tables: 0

ISSN: 1011-7571 (Print)
eISSN: 1423-0151 (Online)

For additional information: http://www.karger.com/MPP


Open Access License / Drug Dosage

Open Access License: This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial 3.0 Unported license (CC BY-NC) (www.karger.com/OA-license), applicable to the online version of the article only. Distribution permitted for non-commercial purposes only.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Cohen J: The scientific challenge of hepatitis C. Science 1999;285:26–30.
  2. Allison MED, Wreghitt T, Palmer CR, Alexander GJM: Evidence of a link between hepatitis C virus infection and diabetes mellitus in a cirrhotic population. J Hepatol 1994;21:1135–1139.
  3. Caronia S, Taylor K, Pagliaro L, Carr C, Palazzo U, Petrik J, et al: Further evidence for an association between non-insulin dependent diabetes mellitus and chronic hepatitis C virus infection. Hepatology 1999;30:1059–1063.
  4. Mehta SH, Brancati GL, Sulkowski MS, Strathdee SA, Szklo M, Thomas DL: Prevalence of type-2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med 2000;133:592–599.
  5. Fabris P, Betterle C, Greggio NA, Zanchetta R, Bosi E, Biasin MR, et al: Insulin-dependent diabetes mellitus during alfa-interferon therapy for chronic viral hepatitis. J Hepatol 1998;28:514–517.
  6. Uto H, Matsuoka H, Murata M, Okamoto T, Miyata Y, Hori T, et al: A case of chronic hepatitis C developing insulin-dependent diabetes mellitus associated with various autoantibodies during interferon therapy. Diabetes Res Clin Pract 2000;49:101–106.
  7. Recasens M, Aguilera E, Ampurdanes S, Sanches Tapias JM, Simo O, Casamitjana R, et al: Abrupt onset of diabetes during interferon-alpha therapy in patients with chronic hepatitis C. Diabet Med 2001;18:764–767.
  8. Eibl N, Gschwantler, Ferenci P, Eibl MM, Weiss W, Schernthaner G: Development of insulin-dependent diabetes mellitus in a patient with chronic hepatitis C during therapy with interferon-alpha. Eur J Gastroenterol Hepatol 2001;13:295–298.
  9. Wasmuth HE, Stolte C, Geier A, Gartung C, Matern S: Induction of multiple autoantibodies to islet cell antigens during treatment with interferon alfa for chronic hepatitis C. Gut 2001;49:596–597.
  10. Dicesare E: Interferon-alpha therapy may induce insulin autoantibody development in patients with chronic viral hepatitis. Dig Dis Sci 1996;41:1672–1677.
  11. McLaren NK, Lan M, Coutant R, et al: Only multiple autoantibodies to islet cells (ICA), insulin, GAD65, IA-2 and IA-2 predict immune-mediated (type-I) diabetes in relatives. J Autoimmun 1999;12:279–287.
  12. Bhatti A, McGarrity TJ, Gabbay R: Diabetic ketoacidosis induced by alfa interferon and ribavirin treatment in a patient with hepatitis C. Am J Gastroenterol 2001;96:604–605.