Age and Hepatitis C Increase Risk of Diabetes for Hemophilia Patients
Diabetes, which causes blood sugar levels to rise too high, is less likely to develop in young men with hemophilia than in the general male population, a U.S. study found.
However, the risk of diabetes rose in older patients and in those who tested positive for hepatitis C (HCV), a virus that causes inflammation in the liver and is a known risk factor for developing diabetes, researchers observed.
“Providers caring for [patients with hemophilia] should intensify diabetes screening in patients who are [60 years or older], especially when HCV positive,” the researchers wrote.
The study, “Risk of diabetes in haemophilia patients compared to clinic and non-clinic control cohorts,” was published in Haemophilia.
Hemophilia results from mutations in genes that carry instructions for making certain clotting proteins. These genes are located in the X chromosome. Women have two X chromosomes, while men have one X and one Y chromosome. Therefore, hemophilia affects males almost exclusively, as they need only to receive one faulty X chromosome from their mother to develop the disease.
Although men with hemophilia appear to be less likely to develop diseases that affect the heart and blood vessels, aging and weight gain pose a concern as these factors can hasten bleeding complications. “Diabetes is also a concern,” the researchers wrote.
The researchers already knew the number of men with hemophilia who have diabetes is lower than the number of men with diabetes in the U.S.
But to see how the risk of diabetes could change, they looked at data from 690 men with hemophilia from four hemophilia centers across the U.S. The men had a median age of 39 and a median body mass index (BMI), a measure of body fat, of 26.2, which is overweight. More than half were considered overweight or obese.
The study also included data from two sets of 3,450 people who were matched by age and sex to hemophilia patients. One group of men had participated in the National Health and Nutrition Examination Surveys (NHANES), a series of regular surveys to monitor health status in the U.S., from 2003–2016. Those in the second group were outpatients of the Veterans Affairs Medical Center (VAMC) in San Diego from 2009–2015. Their median BMI was 27.2 and 28.3, respectively, which was higher than that of the hemophilia patients.
Among men with hemophilia, 50 (7%) had diabetes. This was lower than the 11% seen in the NHANES group and the 19% observed in the VAMC group.
Hemophilia patients are at risk of being infected with a virus such as HCV or the human immunodeficiency virus (HIV) as a result of using contaminated plasma or clotting protein concentrates. In this study, 433 (63%) patients tested positive for HCV and 131 (19%) for HIV. These proportions were much higher than those seen in the general population.
When researchers looked at how the risk of developing diabetes changed with age, they found that it was lower in men with hemophilia than in the general population across all ages. However, for all people, there was “a slow but steady increase in the risk of diabetes with age until the mid-60s, and then a sharp increase.” This pattern was observed regardless of BMI.
Researchers then looked at how the risk of developing diabetes changed with infection status. They found that men with hemophilia who tested positive for HCV had a 3.5 times higher chance of developing diabetes than those who tested negative. This was particularly striking for patients at age 70.
Among people who tested negative for HCV, the risk of diabetes was “considerably” lower for those with hemophilia than the general population.
“The difference persisted after controlling for BMI and age, indicating that the low risk of diabetes in [patients with hemophilia] cannot be explained by lean body mass alone,” the researchers wrote.
The researchers also found the risk of diabetes in patients who tested positive for HIV was 1.7 times higher than in those who tested negative.
“[Patient with hemophilia] are less likely than men in the general population to be afflicted by diabetes. However, an increase in diabetes risk with age was noted, especially in HCV-positive patients,” the researchers wrote.
“These findings inform clinical practice since hemophilia treatment centers are the medical home for many [patients with hemophilia],” they said.