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179856 tn?1333547362

Higher HCC risk with increased insulin resistance

Just FYI - if you have IR you might want to also keep on top of this one too.

Better safe than sorry....I don't want to be the harbinger of doom but I know IR is a problem for some folks around here. I hate HCC if you can't tell.....no more of my friends should die of this.

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Higher HCC risk with increased insulin resistance in hepatitis C patients
May 12, 2010

Recent studies have demonstrated that type 2 diabetes mellitus (DM) is associated with high risk of hepatocellular carcinoma (HCC) development in patients with chronic hepatitis C. Insulin resistance (IR), which correlates inversely with circulating adiponectin concentration, is a consistent finding in patients with type 2 DM. Chronic hepatitis C virus (HCV) infection has been reported to be associated with increased IR. Recent studies suggest that IR plays a crucial role in fibrosis progression, and has been demonstrated to have a negative impact on treatment responses to antiviral therapy in patients with chronic hepatitis C.


A research article to be published on May 14, 2010 in the World Journal of Gastroenterology addresses this question. The research team led by Dr. Hung from Kaohsiung Chang Gung Memorial Hospital prospectively investigated the IR assessed by the homeostasis model (HOMA-IR) and serum adiponectin level in two independent cohorts of consecutive newly diagnosed HCC patients and those with different clinical stages of chronic HCV infection.

Among 165 HCC patients, type 2 DM was more prevalent in HCV subjects compared to hepatitis B virus (HBV) or non-HBV, non-HCV cases. HOMA-IR was higher in HCC patients with HCV than in those with HBV infection. In 188 patients with chronic hepatitis C, HCC subjects had higher blood sugar, insulin level and HOMA-IR than those with chronic hepatitis and advanced fibrosis.

Based on stepwise logistic regression analysis, HOMA-IR was one of the independent factors associated with HCC development. This result was similar even if the diabetic subjects were excluded for analysis. The research team concluded that increased IR, regardless of the presence of diabetes, is significantly associated with HCC development in patients with chronic HCV infection.

These findings may have important prognostic and therapeutic implications in the management of chronic HCV-infected patients. Since IR is a potentially modifiable factor, therapeutic intervention aimed at decreasing IR may be warranted in these patients.

More information: Hung CH, Wang JH, Hu TH, Chen CH, Chang KC, Yen YH, Kuo YH, Tsai MC, Lu SN, Lee CM. Insulin resistance is associated with hepatocellular carcinoma in chronic hepatitis C infection. World J Gastroenterol 2010; 16(18): 2265-2271 http://www.wjgnet.com/1007-9327/full/v16/i18/2265.htm

Provided by World Journal of Gastroenterology (news : web)

http://www.physorg.com/news192880615.html
34 Responses
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Avatar universal
From what I've heard, a score less than 2 is good, and a score greater than 2 indicates Insulin Resistance.  Looks like that's where I'm headed if I don't do something about it.  Good thing I got this checked out.  
Helpful - 0
Avatar universal
Here are my test results.  My Glucose is 88 mg/dL.  My Insulin result is 9.4 uIU/mL.  According to my calculations my HOMA-IR score is 2.04.  I think I'm okay.  



Helpful - 0
Avatar universal
sure - put it on my tab. I'll add it to my collection of dubious bioinformatic software...

But seriously, doesn't the discrepancy seem a bit weird? This isn't just rounding error.  By one measure bandman's numbers indicate serious IR, by the other (newer) index he's very close to in-range. Which is telling the truth?
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568322 tn?1370165440
CS created a HOMA calculator.  I'll send it to you.

Is 25 cents a fair price?  LOL  Want me to add it to your bill?

Co
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Avatar universal
There's something I haven't been able to sort out about the HOMA index calculation - I'd be curious to hear any thoughts/corrections on this.

The simple formula for HOMA1 as Cory writes above is FI*FG/22.5 where FI is fasting insulin in uU/ml and FG is fasting glucose in mMol/L. If FG is reported in mg/dL, common in the US, you first have to change units by dividing by 18. So for bandman's readings, HOMA1 is
(16*(100/18))/22.5=3.94
which would be outside the normal HOMA range and indicate possible IR.

However, HOMA1 has been criticized for high variability and an updated formula, HOMA2, was introduced by the authors

Unfortunately the HOMA2 calculation is not a simple multiplication and involves a non-linear fit. Inputs are the same and it is available from the authors' site
http://www.dtu.ox.ac.uk/homacalculator/index.php
either as an executable or as an excel spreadsheet. For FG=100 mg/dL and FI=16 uU/mL the HOMA2 value is 2.1 which is  close to normal.

Reference  ranges for FG  are normal lt 100 and  FI normal lt 17  - or at least those were the ranges from my last FI/FG tests, the FI reference range may vary depending on test). So  it seems consistent that in-range FI/FG would yield in-range HOMA2.
Helpful - 0
Avatar universal
Well, I do find it rather interesting to note that whenever I have non-fasting liver labs and the glucose is in the panel ..just because.., my blood sugar is perfectly in the normal range and this is after a substantial, rather large breakfast, I might add. ( i.e., eggs, toast, cereal, fruit...),   now I'm not trying to be argumentative but, IF I was IR, one would reason that I would have an elevated blood sugar after a high carb meal?  I'm telling you that my blood sugar was like 70 after eating, toast, whole wheat cereal, egg-whites, fruit, juice, coffee....   The toast was not that cardboard tasting low-carb type, it was just normal variety whole wheat toast.  The cereal was not some type of Kashi or Oatmeal, it was Wheaties complete w/all it's added (god-forbid...little bit of sugar).   And, oh, by the way, I also eat chocolate.  However, my weight is normal for my height.  All the other markers for IR are not there.  I have normal cholesterol, normal triglycerides.  My waist size is within normal limits.  This is based on my doctor's assessment, mind you.  My thyroid is normal.  My blood pressure is normal (in fact on the low side).  So, why is it that so many on here are questioning my statement that I am not IR???  What do you expect me to do, go and stand in front of my doctor w/my hands on my hips and DEMAND that he do a fasting GTT?  There are many reasons why someone can be not clearing the virus and it doesn't always have to fall into the category of IR.  Yes, I do have some elevated blood sugar's, but they are not THAT bad and my doctor said that under to old guidelines, that we would not even be having this conversation.  It's just since they lowered the limits on the blood sugar that this has become an issue.  That's my opinion on this.  Susan400
Helpful - 0
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