Does Diabetes Increase Risk For Viral Hepatitis?

I recently received the following e-mail:

"At my last appointment, my endocrinologist said she wanted me to get flu, pneumonia and hep C vaccinations... Is there any reason to believe that people with type 1 diabetes would need the hep C vaccine?"

This question raises the issue as to whether there is an increased risk of Hepatitis B (also known as Hep B or HBV), or of Hepatitis C (AKA Hep C or HCV), in people with diabetes -- and whether the risk is different for people with type 1 diabetes (T1D) compared to folks with type 2 (T2D).

"Viral hepatitis" is the generic term for what happens when a viral infection attacks and causes inflammation of the liver. There are at least five different viruses that can cause viral hepatitis; Hepatitis A, Hepatitis B, Hepatitis C, Hepatitis D, and Hepatitis E. The most common types are Hepatitis A, B, and C.

Although infection with any of these viruses can cause similar symptoms, they have different modes of transmission and can affect the liver differently. Hepatitis A appears only as an acute or newly occurring infection and does not become chronic. On the other hand, both hepatitis B and hepatitis C can cause chronic liver disease. Moreover, if a person has had one type of viral hepatitis in the past, it is still possible to get any of the other types.

It turns out that people with type 1 or type 2 diabetes mellitus have higher rates of hepatitis B than the general population. As explained by the CDC, "some of the cases of hepatitis B have occurred in individuals with diabetes whose equipment came in contact with infected blood, or who had contact with the virus through breaks in the skin. This has happened through improper reuse and sharing of glucose monitoring equipment or other diabetes care equipment. Transmission has occurred among people with diabetes who reside in assisted living facilities when several people received glucose monitoring in close succession."

So it's not surprising that hep B vaccination is recommended for adults with diabetes: "Hepatitis B vaccination should be administered to unvaccinated adults with diabetes mellitus who are aged 19 through 59 years... Hepatitis B vaccination may be administered at the discretion of the treating clinician to unvaccinated adults with diabetes mellitus who are aged =60 years." It's assumed that children, either those with or without diabetes, are routinely getting HBV vaccine as part of the routine childhood vaccination schedule.

Some research discusses HCV in relationship (or non-relationship) to T2D (although it never mentions whether any purported relationship might also hold for T1D). The article points out the problem of causality -- the huge bugaboo of all epidemiology -- in the studies that have looked for a relationship, and ends up without drawing any conclusions.

Research has proven inconclusive on whether the risk to PWD of getting Hep C is greater than the general public. All people should exercise caution and review their risk factors for Hep C, since no vaccination currently exists for Hep C. The exact opposite is true of Hep B: the risk is greater for PWD, and there is a vaccination.

If you have diabetes, you should be getting several vaccinations if you haven't already done so:

• Pneumonia (technically, pneumococcus vaccination),
• Flu (influenza) (annually), and
• Hepatitis B vaccination.