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.

[jmjm530]

Just want to add that I agree with HRs "points" theory and personally expand it to include doctors, even hepatolgists, i.e. the more pointed expert opinions you get, the more apt you are to go in the right direction. During the course of my treatment I had at least four such points (hepatolgists) giving input at critical junctures. This may be excessive, but I don't think second opinions are.

-- Jim

[jmjm530]

OK, maybe you can clarify things.

I believe you've now had a Fibrotest (or something similar), a Fibroscan, and now a Spanish CatScan LOL. Can you tell us what stage of fibrosis each suggested, and what your medical team thinks what stage of fibrosis you have based on all input so far?  The reason I mentioned "liver biopsy" -- other than it being the gold standard -- is because sometimes individual markers -- like mentioned above -- give conflicting results and therefore you have to dig deeper, so to speak. Since you brought up "HR", I do remember him posting on a similar topic that (this is a paraphrase) the more "points" you have, the more accurate you can draw the line.  The "points" he was referring to included blood marker tests, fibroscan and liver biopsy. It seemed clear to me that he advocated ALL THREE especially in difficult to diagnose cases. Since you're about to contact him, you might ask him about that and see what his opinion is.

-- Jim

[bajawoman]

not cyinical sorry you took it that way
it is in Spanish they both read Spanish that is all I was referring to  baja

[bajawoman]

I ordered a book from Amazon Insulin Resistant diet and it is balancing like the south beach diet and  the zone diet  being one very familiar with diets over the many years
I do think the Insulin Resistance diet is a very good one  I use stevia as a sweetner and HR also recommended for morning coffee which I drink decaf  lactosa or something like that but I have not found it here

I thank you all for your always sincere comments  it means a lot to me as here we do not have support groups and I do not discuss my HCV with anyone except the forums and my doctor here

Diabetes runs in my family on my Dad's side  Co spotted the IR factor or thought I may be IR after a few posts I made back in September and send me a PM  I started to communicate with her through PM's and she helped translate my blood work and also find studies for my Doctor in Spanish   You have to realize we did not have interferon or treatment here until a year ago my GI is the Hep Doctor for Baja Sur and has only been a monitoring doctor as all patients had to go to see a  Hep doctor in Guadalajara to recieve their meds fly back and he would monitor the treatment and report to the doctor there in Guadalajara  Well he has read the studies and the continuing emails from me with further studies and is now testing his patients HOMA  this is Great  He is also sending them to an Endo for treatment of the Diabetes  as it is a big problem here all ages groups  
now we have interferon here and he is now as far as my insurance co. goes my doctor for me to be covered has to order all test etc.  He will work with me and he is anxious for me to start treatment  HR said I can but need to be sure to take alinia and metaformina for a better chance of success
I am grateful that I found out about my IR before just jumping in to tx possibly keeping me from going through relapse
sorry for the long drawn out datribe   baja

[Trinity4]

OK Trin, you're getting side tracked her.  IR seems to have become a religion which I do not follow so I must look at other topics which have equal if not greater importance.

[jmjm530]

Yes, SB Phase 1 is on the money and falls into a family of other metabolic specific diets. It's also doable, the trick is to print it all out, including foods allowed and "not allowed" list.  Basically what I did was first take the "foods not allowed list" and throw out anything in the fridge or cabinets that was on the list.

Then I'd take the "foods allowed" when I went shopping and ONLY buy from the list. That way I knew I was on the diet.

Eating out was more of a challenge but can be accomplished if you really study up on the diet and really analyze what you're being served which includes asking enough questions to annoy even the most patient waiter or waitress. LOL. Frankly, I'd say no eating out for the first month on the diet as that would keep things simpler.