Interesting Study on Insulin Resistance

[MYS]

J Hepatol. 2009 Apr;50(4):712-718.

Insulin resistance predicts response to peginterferon-alpha/ribavirin combination therapy in chronic hepatitis C patients.

Dai CY, Huang JF, Hsieh MY, Hou NJ, Lin ZY, Chen SC, Hsieh MY, Wang LY, Chang WY, Chuang WL, Yu ML.
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Rd, Kaohsiung 807, Taiwan; Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Occupational and Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

BACKGROUND/AIMS: Insulin resistance (IR) might be associated with hepatitis C virus (HCV) infection. This study aimed to elucidate impact of IR and beta-cell function on the response to peginterferon-alpha (PEG-IFN)/ribavirin combination therapy in chronic hepatitis C (CHC) patients.

METHODS: Three hundred and thirty patients without overt diabetes were treated with combination therapy with (PEG-IFN)/ribavirin for 24 weeks. The IR and beta-cell function were evaluated by homeostasis model assessment of IR (HOMA-IR) and homeostasis model assessment of beta-cell function (HOMA-beta) before treatment.

RESULTS: HCV genotype, pretreatment HCV RNA level and pretreatment HOMA-IR, but not HOMA-beta, were independent factors associated with sustained virologic response (SVR). In 150 patients with genotype 1b infection, pretreatment HCV RNA level, HOMA-IR and age were independent predictors for SVR. The significantly lower SVR rate in high HOMA-IR patients was observed in 76 patients with high HCV RNA levels (400,000IU/mL) who were defined as 'difficult-to-treat' patients. The mean HOMA-IR of 'difficult-to-treat' patients was significantly lower in 42 sustained responders than in 34 non-responders.

CONCLUSIONS: IR was associated with SVR to (PEG-IFN)/ribavirin therapy for CHC, especially among 'difficult-to-treat' patients. These findings suggested clinical application of pretreatment HOMA-IR could enable treatment outcome to be predicted and treatment regimens to be determined.

[bandman54]

"Second person just got the results of his 2 Week viral load....89.  And we made sure he wasn't IR before startin g Tx.  AND he is also a previous non-responder.  (he used the same approach as CS). "

question - did this person have insulin resistance??  And if so, did he take metformin before and during tx??

Just wondering....

bandman

[FlGuy]

Thank you. Now for a follow-on.  The doc asks me to take readings, he suggests taking a fasting reading (upon waking) and on alternating days two hours after lunch.  (I usually have three meals a day, can't manage  5-6 small feedings per day).  If I take the met. with breaksfast (after the fasting reading) and take the pm metformin with dinner (7 PM) am I getting a reliable reading if I take the reading after lunch which would be 7.5 hour after AM dose and 4.5 hours before PM dose?

[CoWriter]

Half life of Metformin is very short 6.2 hours and it's excreted in the urine.

Metformin should be taken with meals.  For example, if you take it twice a day, then it should be taken with breakfast and dinner.

Co

[FlGuy]

I am wondering if you are familiar with the 'life' of metformin.  Using riba as an example, it works up to a saturation level over time and eventually reaches a steady state.  Is it the same for metformin, or is the life of metformin much shorter. And further, is dosing of metformin strategic in terms of meals? Thanks.

[CoWriter]

Thanks for posting the link.  Very interesting.  According to the Gomez-Romero study, Blacks are considered "difficult to treat" because they are IR.  So it seems that the topic of IR just got alot more complicated and alot more interesting.

Thanks again!

Co

[CoWriter]

I sent you the full text of the initial study MYS posted.

Anybody else who would like a copy please contact me via PM.

Co