title: Insulin sensitivity and variability in hepatitis C virus infection using direct measurement.
abstract: OBJECTIVE
  Studies investigating insulin resistance (IR) in chronic hepatitis C virus (HCV) infection have used surrogate measures of IR that have limited reliability. We aimed to describe the distribution and risk factors associated with IR and its change over time in HCV using direct measurement.
  
  
  METHODS
  One hundred two non-cirrhotic, non-diabetic, HCV-infected subjects underwent clinical, histologic, and metabolic evaluation, and 27 completed repeat evaluation at 6 months. Insulin-mediated glucose uptake was measured by steady-state plasma glucose (SSPG) concentration during the insulin suppression test.
  
  
  RESULTS
  Three subjects with diabetes were excluded and 95 completed all testing. SSPG ranged from 39 to 328 mg/dL (mean 135 mg/dL) and was stable over time (mean SSPG change -0.3 mg/dL). SSPG was associated with Latino ethnicity (Coef 67, 95 % CI 37-96), BMI (Coef 19 per 5 kg/m(2), 95 % CI 5-32), ferritin (Coef 1.4 per 10 ng/ml, 95 % CI 0.2-2.5), male gender (Coef -48, 95 % CI -80 to -16), and HDL (Coef -16, 95 % CI -28 to -5 mg/dL). Current tobacco use (Coef 55, 95 % CI 19-90), steatosis (Coef -44, 95 % CI -86 to -3), and increases in BMI (Coef 30 per 5 kg/m(2), 95 % CI 6-53) and triglyceride (Coef 3.5 per 10 mg/dL, 95 % CI 0.3-6.7) predicted change in SSPG.
  
  
  CONCLUSIONS
  There was a wide spectrum of insulin resistance in our HCV population. Host factors, rather than viral factors, appeared to more greatly influence insulin action and its change in HCV.
authors.affiliation: Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Nizar A
authors.initials: NA
authors.lastname: Mukhtar
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Claudia E
authors.initials: CE
authors.lastname: Ayala
authors.forename: Jennifer
authors.initials: J
authors.lastname: Melgar
authors.forename: Spencer
authors.initials: S
authors.lastname: Christensen
authors.forename: Jacquelyn J
authors.initials: JJ
authors.lastname: Maher
authors.forename: Mandana
authors.initials: M
authors.lastname: Khalili
mesh_terms: D000328:Adult; D001786:Blood Glucose; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000821:virology; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose