Letter: Post-HCV Cure, Precision Assessment of Liver Stiffness and Diabetes Risk in Maternal Populations-A Critical Research Need. Authors' Reply.
Journal
Alimentary pharmacology & therapeutics
Journal Volume
62
Journal Issue
1
Start Page
95
End Page
96
ISSN
1365-2036
Date Issued
2025-07
Author(s)
Abstract
We thank Guan et al. for their interest in and critical comments on our work regarding the risk of incident type 2 diabetes (T2D) and prediabetes among individuals who achieve hepatitis C virus (HCV) cure with direct-acting antivirals (DAAs) [1, 2]. First, our study assessed liver stiffness measurement (LSM) at the time point of sustained virologic response at off-therapy week 12 (SVR12). While the cut-off values using vibration-controlled transient elastography (VCTE) have been well defined for staging hepatic fibrosis before HCV treatment, the optimal LSM cut-off values for assessing hepatic fibrosis following viral cure remain unclear [3-5]. Given this limitation, we evaluated the effect of LSM on the risk of T2D or prediabetes as a continuous variable rather than a categorical one. Furthermore, using a continuous variable in regression models provides deeper insight into how per-unit changes in variables relate to outcome development, as shown in our univariable and multivariable models for age, body mass index (BMI), fibrosis index based on four parameters (FIB-4) and estimated glomerular filtration rate (eGFR) [6]. Second, our study clearly implemented biannual blood testing for fasting glucose and glycosylated haemoglobin (HbA1c). While our patients did not undergo oral glucose tolerance test (OGTT), incorporating OGTT in addition to fasting glucose and HbA1c levels is not mandatory to diagnose T2D or prediabetes, according to guidelines from the American Diabetic Association (ADA) [7]. Although OGTT can help confirm a diagnosis of T2D or prediabetes, it is generally unappealing to participants due to its cumbersome and time-consuming nature. Regarding the development of abnormal blood glucose levels during DAA treatment, we reviewed the glycaemic history of all participants prior to viral cure to accurately determine baseline glycaemic status at SVR12. We excluded participants who developed T2D before viral cure or who were taking antidiabetic medications, regardless of glycaemic status, as these treatments could misclassify baseline glycaemic status and potentially underestimate the risk of incident T2D or prediabetes during the post-SVR12 follow-up period. Lastly, we agree with Guan et al.'s concern regarding glycaemic dynamics during pregnancy, either during HCV treatment or after achieving viral cure. Due to the undefined safety profile of DAAs in pregnant women, we excluded any participants who received DAAs during pregnancy. Moreover, as nearly all women in our study were beyond childbearing age, and none were pregnant during the post-SVR12 follow-up, it was not possible to compare glycaemic dynamics in this special population to others. Our study highlights the importance of continuous glycaemic monitoring in patients with HCV, particularly those at risk of developing incident T2D or prediabetes, even though insulin resistance (IR) tends to improve following successful antiviral treatment [8]. we appreciate the constructive criticism from Guan et al., which can help advance the exploration of unresolved issues related to glycaemic dynamics in the future. Yu-Ping Chang: writing – original draft, writing – review and editing. Jia-Horng Kao: writing – original draft, writing – review and editing. Chen-Hua Liu: writing – original draft, writing – review and editing. The authors' declarations of personal and financial interests are unchanged from those in the original article [2]. This article is linked to Chang et al. papers. To view these articles, visit https://doi.org/10.1111/apt.70029 and https://doi.org/10.1111/apt.70164. Data sharing is not applicable to this article as no new data were created or analyzed in this study.
SDGs
Type
letter