To Evaluate the Frequency of Diabetes Mellitus Patients with Hepatitis C at Tertiary Hospital of Sindh, Pakistan

Objective: The major theme of the research was to evaluate the frequency of diabetes mellitus patients with hepatitis C infection at tertiary care hospital of Sindh, Pakistan. Methodology: Descriptive cross sectional study was conducted at tertiary care hospital of Sindh, Pakistan for the period of 08 months; total 374 sample size was calculated by using Rao soft sample size calculator at the prevalence rate of 58.3% and confidence level 95% and margin of error 5%. Data was collected from patients of sero-positive HCV-RNA (Hepatitis C Virus-Ribose Nucleic Acid) visiting outpatient department or admitted at tertiary care hospital of Sindh, Pakistan and Informed consent form was also filled from all included subjects and data was analyzed by Original Research Article Mewaram et al.; JPRI, 33(27B): 34-38, 2021; Article no.JPRI.67642 35 using SPSS software version 24.00. Results: From the 374 patients 209 were males and 165 females and all participants were divided in to various age groups as 15 patients were in the age group of 20-25 years, 67 patients were in 26-30 years, 48 patients included in 31-35 years and 109 patients were included in to age group of 36-40 years. Only 12 patients were included in the age group of 50 years and above. Total 164 (43.85%) were diabetic and 229 (61.22%) were diagnosed with Hepatitis C RNA (Ribose Nucleic Acid) positive. Patients had various range of HbA1c as 93 patients had range between 6-7mmol/dl. 107(28.60%) included in 7-9mmol/dl, 145(38.77%) included in 9-11mmol/dl and only 29 patients were having HbA1c (Glycated Hemoglobin) level above 11mmol/dl. Conclusion: It was concluded that there were increased number of diabetic patients with hepatitis C in worsening condition, so the proper programs should be conducted in order to reduce the complication of co-morbid disease.


INTRODUCTION
Worldwide, Hepatitis is considered as most infectious disease that affects approximately 5% of population and 35 million people drying every year just because of Hepatitis C and related type infectious diseases [1,2]. Prevalence rate of Hepatitis C in Pakistan is 5% and its rate is increasing on daily basis just because of sharing infected things as it is considered as air borne disease and easily transfers from person to person [3,4]. Almost 180 million were suspected to have liver cirrhosis and liver cancer every year around the globe. The major cause of liver cancer is Hepatitis as per recommendation of World Health Organization [5,6]. According to mortality rate described by world health organization diabetes mellitus got eighth position in 2013. Near about 3-4 million people died every year due to diabetes mellitus and in Pakistan the frequency of diabetes is increased in general population [7,8].
According to numerous research studies, liver infections increased the glycemic level due to producing the insulin resistance but the mechanism is still unknown but the research studies recommend that there is direct interaction of Hepatitis with receptor of insulin via proinflammatory cytokines [9,10]. Ethawary et al. had found in HCV sero-positive patients, 13.84% of patients had diabetes mellitus. Sindhu et al. elaborated about the strong co-relation among the patients of hepatitis C and Diabetes Mellitus. [11] According to observational research conducted by Ansari et al. found Diabetes in 60% of patients with HCV patients [12,13] . According to recent approach of research, it was concluded that Diabetes management is directly proportional to the Liver disorders and its symptoms become worsen within a person who have hepatitis or related disorders [14,15]. Insulin resistance is considered as severe pathogenic factor that produces hindrances in the signaling within cells of livers, beside this secretion of inflammatory mediators and oxidative stress are considered as related factors involved for the worsening condition of Diabetes among the hepatitis patients [16,17]. According to report published in Pakistan Medical Research Council, there is increased number of patients of Hepatitis with diabetes as compared to diabetic patients without hepatitis [18]. So, the major theme of research was to evaluate the frequency of patients of hepatitis with diabetes, as to estimate the complication and co-morbid condition can be achieved [19,20]

METHODOLOGY
Descriptive cross sectional study was conducted at tertiary care hospital of Sindh, Pakistan for the period of 08 months from February 2020 to September 2020 and total 374 sample size was calculated by using Rao soft sample size calculator at the prevalence rate of 58.3% and confidence level 95% and margin of error 5%. Diabetes was diagnosed by different diagnostic test including Random glucose test and fasting glucose test and Hepatitis was also confirmed through various lab test including liver functioning test & HCV antibodies test. Data was collected from patients of sero-positive HCV-RNA visiting outpatient department or admitted at tertiary care hospital of Sindh, Pakistan and Informed consent form was also filled from all included subjects and data was analyzed by using SPSS software version 24.00.

RESULTS
Research was conducted on 374 patients who were either admitted in Medicine ward or come for OPD (Outdoor Patient Department) at Medicine Department of Tertiary care hospital of Sindh, Pakistan. Patients with diabetes mellitus along with Hepatitis C were selected for the study and 209 were males whereas 165 were females as mentioned in Table 1.

DISCUSSION
Globally, severe liver infections are considered as route cause for increased disease and death ratio and it had prevalence rate of approximately 15%. The frequency of death with liver problems was about 20 individuals per 1 lac. The prevalence rate among hepatitis patients was approximately 14%. Globally, the prevalence rate of diabetes is almost 10% among the local population with equal division in each gender. The general health issues including Diabetes and Hepatitis pretense bad impact on the health of local population specially when these types of co-morbid occurs together simultaneously. In current research the occurrence of diabetes among the hepatitis C patients was quite greater than the expected values. From the given figure  62% people were newly diagnostic cases whereas 38% people were previously diabetic people. These diabetic people were totally depending on the diets not on any medications. In previous literatures, the prevalence of hepatitis C among diabetic people had shown with wide range from 15-65% [12][13]

CONCLUSION
From the current study, it was concluded that recently diagnosed diabetic cases had found among the people with hepatitis C. So, further researches are compulsory to enhance the sufficient and cost related seminars for the management of Diabetes mellitus that gave proper reactions against to antiviral therapy, when the diabetes is not managed properly.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).