Direct-acting antivirals for chronic hepatitis C - risk of hypoglycaemia in patients with diabetes

• glucose levels should be monitored closely in patients with diabetes during direct-acting antiviral therapy for hepatitis C, particularly within the first 3 months of treatment
  • modify diabetes medication or doses when necessary
• patients with diabetes may experience symptomatic hypoglycaemia if diabetic treatment is continued at the same dose due to potential for an enhanced hypoglycaemic effect.

Advice for healthcare professionals:

• rapid reduction in hepatitis C viral load during direct-acting antiviral therapy for hepatitis C may lead to improvements in glucose metabolism in patients with diabetes, potentially resulting in symptomatic hypoglycaemia
  
  
• if diabetic treatment is continued at the same dose be vigilant for changes in glucose tolerance and advise patients of the risk of hypoglycaemia during direct-acting antiviral therapy, particularly within the first 3 months when the viral load is being reduced, and modify diabetic medication or doses when necessary
  
  
• physicians who initiate direct-acting antiviral therapy in patients with diabetes should inform the healthcare professional in charge of the diabetic care of the patient

Notes (2):

• direct-acting antiviral (DAA) eradication of HCV is associated with improved glycemic control in patients with diabetes as evidenced by decreased mean HbA1c and decreased insulin use

Reference:

• MRHA (December 2018). Direct-acting antivirals for chronic hepatitis C: risk of hypoglycaemia in patients with diabetes..
• Hum J et al.Improvement in Glycemic Control of Type 2 Diabetes After Successful Treatment of Hepatitis C Virus.Diabetes Care. 2017 Sep;40(9):1173-1180