The Relationship of Hepatitis Antibodies and Elevated Liver Enzymes with Impaired Fasting Glucose and Undiagnosed Diabetes

November 10, 2008

The Journal of the American Board of Family Medicine 21 (6): 497-503 (2008)

DOI: 10.3122/jabfm.2008.06.080047

The Relationship of Hepatitis Antibodies and Elevated Liver Enzymes with

Impaired Fasting Glucose and Undiagnosed Diabetes

Arch G. Mainous, III, PhD, A. , MD, MS, Dana E. King, MD, MS,

J. Everett, MD, MS and Marty S. Player, MD, MS

From the Department of Family Medicine, Medical University of South Carolina,

ton

Correspondence: Corresponding author: Arch G. Mainous III, PhD, Department of

Family Medicine, Medical University of South Carolina, 295 Calhoun St.,

ton, SC 29425 (E-mail: mainouag@...)

Objective: The aim of this study was to examine the relationship of hepatitis

antibodies and liver enzymes with impaired fasting glucose and undiagnosed

diabetes in adults.

Methods: We analyzed the National Health and Nutrition Examination Survey, 1999

to 2004, a nationally representative sample of the noninstitutionalized US

population. Among adults (aged 20 years of age) who were not problem drinkers,

we examined hepatitis B and C antibodies and the liver enzymes aspartate

aminotransferase (AST), alanine aminotransferase (ALT), and glutamyl

transaminase (GGT) with impaired fasting glucose and undiagnosed diabetes

(unweighted, n = 5234; weighted, n = 172,626,805). Logistic regression models

were computed controlling for major risk factors that drive diabetes screening,

including age, gender, race, diagnosed hypertension, diagnosed

hypercholesterolemia, and obesity.

Results: In unadjusted analyses 51% of individuals with undiagnosed diabetes

have elevated GGT versus 20% of individuals without diabetes or impaired fasting

glucose (P = .01). Similarly, 43% of individuals with undiagnosed diabetes have

elevated ALT versus 23% of individuals without diabetes or impaired fasting

glucose (P = .01). AST and Hepatitis C antibodies were not associated with

undiagnosed diabetes. In adjusted analyses, elevated GGT (odds ratio, 2.15; 95%

CI, 1.44–3.20) and ALT (odds ratio, 1.84; 95% CI, 1.06–3.20) are associated with

undiagnosed diabetes. Similarly, in adjusted analyses, elevated GGT (odds ratio,

1.23; 95% CI, 1.00–1.53) and ALT (odds ratio, 1.44; 95% CI, 1.15–1.79) are

associated with impaired fasting glucose. Hepatitis antibodies, reporting a

current liver problem, or AST were associated with having undiagnosed diabetes

in adjusted analyses.

Conclusions: Liver function is associated with undiagnosed diabetes and impaired

fasting glucose and may justify further investigation as a risk stratification

variable for undiagnosed diabetes or impaired fasting glucose.

November 10, 2008