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    Surely you must have heard about hepatitis. In fact, this is a generic term to refer to diseases that cause inflammation of the liver. The consequences includes cirrhosis, hepatic steatosis and even organ transplantation.

    There are different viral hepatitis such as, types A, B and C. Among them, type C is the most worrying for the development of metabolic diseases, and diabetes is among them.

    Given the prevalence of infection, it is essential that the population know the importance of early diagnosis. This helps in avoiding the dangerous association between diabetes and hepatitis C.

    What is the outlook for hepatitis C in the world?

    Background concept wordcloud illustration of cirrhosis

    Hepatitis C is a disease cause by the virus of the Hepacivirus genus. According to data from the World Health Organization, about 170 million people worldwide are infected by the virus, presenting the chronic form of the disease.

    In fact, this is a very important characteristic when it comes to hepatitis C. The condition manifests itself in a chronic form. The progression of the disease lasts, on average, from 25 to 30 years. Therefore, there is a delay in the development of the usual clinical manifestations.

    The main reason for this is the great capacity of the liver to regenerate itself. However, even with this organ specificity, hepatitis C represents the most frequent indication for liver transplantation . To make matters worse, 70% of infected people do not know they are infected.

    What does the disease do to the liver?

    The liver is an organ with a very important regulatory role in the body. In fact, its best known function is detoxification. This means it is responsible for metabolizing ingested substances, such as medication, alcohol, among others.

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    However, the liver has another essential function: to regulate the metabolism of lipids, popularly known as fats. In addition, it also participates in energy metabolism and, together with the pancreas, performs activities to store or spend glucose.

    Returning then to hepatitis C, an infected individual has liver cells contaminated by the virus, which begin to reproduce inside them. The microorganism has the ability to modulate the metabolism of fats and thus favor its own replication.

    The impact of this is to increase lipogenesis, that is, to increase both the number and size of the droplets of fat that exist within the liver. This condition is popularly known as “liver fat” or also hepatic steatosis.

    What is the relationship between diabetes and hepatitis C?

    But, what is the role of the virus with a higher incidence of diabetes? To understand this, we need to clarify what insulin resistance is.

    What is insulin resistance?

    When we eat, foods belonging to the carbohydrate group, mainly, are convert into glucose almost entirely. This glucose is an essential substrate for energy production. But for that it needs to be picked up from the bloodstream and introduced into a cell.

    Insulin is a hormone produce by the pancreas and its function is to capture and transport glucose into the cell. In individuals with diabetes, insulin production is absent or in insufficient amounts.

    Such case of type 2 diabetes, in which the amount of insulin is insufficient for the demand, it is observe that this insufficiency is due to resistance to the hormone. In other words, the response to the hormone diminished over time, thus creating resistance to it.

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    How does the virus increase resistance?

    The hepatitis C virus increases the risk of developing diabetes by altering the metabolic pathways of insulin. Thus, the performance of the hormone is impair. This is by the resistance environment generated.

    Among the changes caused by the virus, we can mention:

    • inhibition of cellular signals generated by insulin;
    • oxidative stress;
    • greater activation of inflammatory factors;
    • dysfunction of insulin-producing cells.

    Practically, the body releases a certain amount of insulin to maintain blood glucose at adequate values. However, as the cells are resistant to the hormone’s action, the pancreas understands that it must release even more insulin to meet the needs.

    Over time, excessive demand causes insulin-producing cells to enter the process of cell death. Consequently, insufficient production increases the propensity for developing diabetes.

    Hepatic steatosis caused by the virus associated with diabetes causes the so-called visceral obesity. This visceral obesity represents the increase in fat in the organ. It is noteworthy that the prevalence of type 2 diabetes is higher in hepatitis C when compared to other types.

    Finally, in addition to steatosis, there is an acceleration in the process of liver fibrosis and, consequently, cirrhosis. In addition, there is also a high risk of developing hepatocarcinoma — liver cancer.

    How important is a timely diagnosis?

    Hepatitis A, B, C, D, cirrhosis,

    Most people who are with the hepatitis C virus are unaware that they are infect. Therefore, the first step is to take steps to identify the disease.

    Given this scenario, the Brazilian Society of Diabetes mobilized the population for a campaign called Na Ponta do Dedo. Thus, rapid anti-HCV tests takes place, capable of diagnosing the virus.

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    It is necessary to analyze whether insulin resistance is already establish, this is after identifying the disease. If it is, then the management is mainly through the use of metformin. Metformin is a drug whose use is widespread in the treatment of diabetes.

    It is worth mentioning that medical advice should consider the degree of liver involvement. In patients with severe hepatic impairment, for example, the use of metformin is contraindicate.

    However, if its use is allowed, some benefits have already been proven, such as:

    • advantages in the face of the virus response;
    • reduced progression to hepatocarcinoma;
    • decrease in deaths from liver dysfunction;
    • lower occurrence of liver transplantation.

    It is worth mentioning that, in addition to reducing cases of liver cancer, it also increased the survival of people who had already developed it. To fight the virus directly, antivirals are use.

    Given the risks in the dangerous relationship between diabetes and hepatitis C, the key point is to detect the virus infection in a timely manner. For this, preventive measures must be use in both areas: carrying out tests capable of detecting the infection and, in infect individuals, performing exams capable of providing a diagnosis of diabetes. Once the conditions are confirmed, the measures should soon be put into practice, either through medication or by encouraging better lifestyle habits, such as controlling cholesterol and stopping the consumption of alcoholic beverages .

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