SUN-689 Treatment of Hepatitis C Has Time-Dependent Relationship with Type 2 Diabetes Progress

Introduction Hepatitis C virus (HCV) is not only related to hepatic impairment but also associated with metabolic complications, such as glucose intolerance and lipid dis-regulation. In addition, HCV can affect pancreatic Beta-cells function. There are multiple controversial reports regarding the relationship between antiviral treatment and diabetes mellitus (DM) development. We performed continuous observation of a long-term nursing home facility DM patient treated with HCV. Case Presentation 52 y/o white male nursing home patient history of hepatitis C and type 2 diabetes mellitus was treated with ledipasvir/sofosbuvir (90 mg - 400 mg) for 12 weeks. Prior to HCV treatment patient DM control was treated with oral medications (metformin and glipizide) with fast glucose level fluctuating 143±44 mg/dl; 2 hours postprandial level 205±57mg/dl; HbA1c 7.0%. There was no significant change of finger sticks during the 12 weeks of HCV treatment fast glucose 121 ±27 mg/dl and 2 hours postprandial level 176±62 mg/dl.DM management remained the same treatment plan. In the first three months after HCV treatment course patient DM was progressively getting worse with fast glucose level 221±56mg/dl; 2 hours postprandial levels 300±71 mg/dl. HbA1c 8.7% (3 months after HCV treatment). Oral DM medications were doubled dosages and maximum dosage of pioglitazone was added on. In addition, insulin sliding scale and long acting insulin accumulated daily dosage around 120 units. Starting from four months after HCV treatment patient DM was gradually improving evidenced by fast glucose levels 92±10mg/dl and 2 hours postprandial levels 117±30 mg/dl; HbA1c 5.6% with the same management strategies. Seven months after HCV treatment patient DM was stable with fast glucose levels 91±8 mg/dl and 2 hours postprandial levels 115±29 mg/dl; HbA1c 4.8% and insulin sliding scale and glipizide were discontinued. Long acting insulin dosage was decreased to 74 units daily. Eighteen months after HCV treatment patient fast glucose levels and 2 hours postprandial levels were in normal range and HbA1c 5.6%. Discussion Based on our observation there are four phases of DM development related to the HCV treatment: phase I silence stage (during 3 month HCV treatment) DM is stable; phase II deterioration stage (First 3 month after HCV treatment) DM is progressively getting worse; phase III recovery stage (4 to 6 month after HCV treatment) DM is gradually improving; phase IV stabilization stage (6 month after HCV treatment) DM is stabilized and improved. Conclusion Anti-viral treatment of HCV has possible intrinsic time-dependent relationship with DM development.