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Improving HCV Response With Insulin Resistance

Nicole Cutler L.Ac. June 9, 2010

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Could insulin resistance be getting in the way of your Hepatitis C treatment? To manage this possible complication, discover why many experts advise prescribing medications to manage insulin resistance in an effort to improve Hepatitis C treatment outcomes.

Occurring in up to half of American adults, insulin resistance describes when the body can’t properly use insulin to maintain normal blood sugar levels. Unfortunate for those affected, research has consistently shown that those with Hepatitis C infection and insulin resistance are more likely to suffer from liver disease progression. Thus, scientists around the globe have been focusing on how to improve the therapeutic outcome of those with insulin resistance who are battling the Hepatitis C virus.

In their search for a common denominator uniting the growing prevalence of obesity, fatty liver disease, congestive heart failure, high cholesterol, elevated blood pressure and diabetes mellitus, health officials agree that insulin resistance appears to fit the profile. Generalized descriptions of the events that lead to insulin resistance are described below:

  • Released by the pancreas, insulin is dispersed into the bloodstream in response to elevated blood sugar (glucose) levels.
  • By pushing glucose out of the bloodstream and into the body’s cells, insulin keeps blood glucose levels from becoming too elevated and allows cells to convert glucose into energy.
  • Insulin-resistant cells do not allow for the proper conversion of glucose into energy, resulting in fatigue.
  • This resistance to insulin does not permit glucose to enter the cells but, rather, causes it to accumulate in the blood.
  • In an attempt to reduce the glucose levels in the blood, the body signals the pancreas to produce and release even more insulin.
  • The cycle of insulin-resistant cells causes even more insulin to be released, resulting in high blood insulin levels, which could potentially develop into Type 2 diabetes mellitus.

Several studies have shown that people with chronic Hepatitis C are more likely to have insulin resistance or diabetes than those without Hepatitis C. In addition, insulin resistance is associated with a poorer response to interferon-based therapy. To manage this complication, many experts advise prescribing medications to manage insulin resistance in an effort to improve Hepatitis C treatment outcomes.

As revealed at the 2008 American Association for the Study of Liver Diseases Meeting and published in the August 2009 edition of Hepatology, Spanish researchers found that metformin improved virologic response when added to Hepatitis C interferon-ribavirin therapy in those with insulin resistance. Also known by one of its brand names Glucophage, metformin is an oral medication that helps lower blood sugar in three ways:

  1. It lowers the amount of glucose absorbed from food.
  2. It lowers the amount of glucose produced by the liver.
  3. It increases the body’s response to insulin.

Led by Manuel Romero-Gomez, MD, of Valme University Hospital in Seville, 123 patients with genotype 1 Hepatitis C and insulin resistance [homeostasis model of insulin resistance (HOMA) greater than 2] received standard peginterferon-alpha-2a/ribavirin antiviral therapy plus metformin or matching placebo. After six months, the following was determined:

  • 67.4 percent of the metformin group had sustained virologic response compared with 49.1 percent of the placebo group
  • 57.7 percent of women in the metformin group had sustained virologic response compared with 28.6 percent of women in the placebo group

While the participants who received triple drug therapy (metformin + pegylated interferon + ribavirin) had a better outcome than those without metformin, women had a more dramatic reduction in their viral levels than men.

Adding metformin to antiviral combination therapy may not be the solution for everyone with insulin resistance and Hepatitis C infection. However, Romero-Gomez’s research further confirms that taking steps toward maintaining healthy blood sugar levels hinders liver disease progression and increases the likelihood of beating the Hepatitis C virus.

References:

http://www.healthrenewal.org/nhrblog/?p=67, Over 50% of Americans Have Insulin Resistance – Do You?, Dr. Patrick Nemecheck, Retrieved November 28, 2009, healthrenewal.org, 2009.

http://www.hivandhepatitis.com/2008icr/aasld/docs/112108_a.html, Therapies to Manage Insulin Resistance Improve Response to Interferon-based Therapy in Chronic Hepatitis C Patients, Liz Highleyman, Retrieved November 28, 2009, hivandhepatitis.com, 2009.

http://www.liversupport.com/wordpress/2007/08/the-natural-supplement-for-metabolic-health/, The Natural Supplement for Metabolic Health, Nicole Cutler, L.Ac., Retreived November 28, 2009, Natural Wellness, 2009.

http://www.medpagetoday.com/Gastroenterology/Hepatitis/3450, Fat Gets in the Way of Hepatitis C Therapy, Neil Osterweil, Retrieved November 24, 2009, MedPage Today, LLC, 2009.

http://www.medpagetoday.com/MeetingCoverage/AASLD/11662, AASLD: Metformin Effective Add-On in HCV Treatment, Charles Bankhead, Retrieved November 24, 2009, MedPage Today, LLC, 2009.

http://www.ncbi.nlm.nih.gov/pubmed/19845037, Treatment of insulin resistance with metformin in naïve genotype 1 chronic hepatitis C patients receiving peginterferon alfa-2a plus ribavirin, Romero-Gomez M, et al, Retrieved November 25, 2009, Hepatology, August 2009.

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