Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Dr Kashyap and colleagues
and Drs Schattner and Knobler, several retrospective studies have examined
the possible association of HCV and diabetes mellitus.1-4 Some
have found a strong association and others have not. It is important to note
that HCV may be a marker for an associated factor that predisposes to diabetes
mellitus. For example, cirrhosis in general is associated with insulin resistance
and diabetes.5 Thus, a diagnosis of diabetes
in a patient with cirrhosis secondary to HCV may be related to the presence
of cirrhosis and not HCV. Furthermore, obesity is associated with diabetes
and may also hasten progression of liver disease secondary to HCV.6 Obese patients with diabetes (and HCV) may present
more frequently for medical evaluation and thus lead to an apparent increased
prevalence of diabetes in the HCV population. Few studies that have sought
an association between HCV and diabetes have been controlled for severity
of liver disease and body mass index. Schattner and Knobler mention that more
adverse hepatic histology and increased body mass index may be associated
with an increased risk of diabetes in patients with chronic HCV. Although
a direct association between HCV and diabetes is posible, it remains unproven.
Flamm SL. Risks of Smallpox Vaccination. JAMA. 2003;290(11):1452. doi:10.1001/jama.290.11.1452-a
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