Exploring the Overlooked Link Between Hepatitis and Type 2 Diabetes

t2diabetesnetwork
Jun 16
5 min read

Updated: Jun 23

Blog Highlights

✅ Hepatitis C significantly increases the risk of type 2 diabetes.

✅ The liver plays a central role in blood sugar regulation.

✅ Shared risk factors affect underserved populations most.

✅ Coexisting hepatitis and T2D lead to worse health outcomes.

✅ Integrated screening and care can improve patient outcomes.

🎧 Prefer to listen? Tune into the podcast version of this blog postMonica AI

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July hosts the World Hepatitis Awareness day on July 28th each year. But when most of us think about hepatitis, we picture liver disease. When we think about type 2 diabetes (T2D), we think about sugar, insulin, and diet. But what if these two conditions are more connected than you think?

The surprising link between liver disease and blood sugar problems isn’t just a scientific curiosity, it has real-life implications for millions of people around the world, including here in Canada.

Why this Connection Matters

Emerging research highlights a significant interplay between hepatitis and T2D, particularly within the Canadian healthcare landscape. For healthcare professionals, recognizing this connection is crucial, as it can shape patient care, treatment strategies, and public health approaches. This blog explores how these conditions are linked, the risk factors they share, and what it means for integrated healthcare.

Understanding Hepatitis and T2D

Hepatitis is inflammation of the liver, most commonly caused by viral infections (like hepatitis A, B, and C), alcohol use, or autoimmune diseases. In Canada, an estimated 387,000 individuals live with chronic hepatitis C, according to Catie. This substantial number highlights the importance of awareness and screening for hepatitis.

What are the types of hepatitis - find out in this short snip from the Mayo Clinic.

T2D, meanwhile, is a metabolic disorder where the body becomes resistant to insulin, leading to elevated blood sugar levels. It can result in serious complications, including heart disease and kidney failure. With the growing prevalence of T2D in Canada, understanding its connection to liver health is more important than ever.

The Liver–Glucose Connection

The liver plays a central role in regulating blood glucose by storing glucose as glycogen and releasing it when needed. It also influences insulin sensitivity and fat metabolism. In cases of chronic liver inflammation, such as hepatitis B or C, this delicate balance is disrupted. Over time, the liver can become insulin resistant, and its ability to manage glucose and lipids deteriorates - raising the risk of developing T2D.

What the Research Shows

Numerous studies have identified a strong link between chronic hepatitis C virus (HCV) infection and T2D:

A meta-analysis found that people with HCV are 1.7 times more likely to develop diabetes than those without the virus.
Up to 33% of people with chronic HCV also show evidence of glucose abnormalities, including impaired fasting glucose and insulin resistance.
In populations with high rates of HCV, such as people who inject drugs, the rates of T2D are significantly elevated, suggesting a double burden of disease.

HCV is believed to trigger insulin resistance through both direct viral effects on liver cells and through the production of pro-inflammatory cytokines, which interfere with insulin signaling pathways. Additionally, HCV infection is associated with hepatic steatosis (fatty liver), which further increases insulin resistance.

The relationship between hepatitis B virus (HBV) and T2D is less pronounced than with HCV, but it still exists.

Some population-based studies have found a moderate increase in diabetes risk among individuals with HBV.
Outbreaks of HBV in long-term-care facilities were notably linked to adults with diabetes.
In North America, people with HBV have been observed to have higher rates of T2D compared to the general population.

But hope is not lost - people with hepatitis are making changes in their communities to improve health outcomes. Hear how Shabana is making an impact in Yorkshire.

Shared Risk Factors: Why Some People Face Both

Both hepatitis and T2D often affect similar groups, especially underserved populations. Factors like socioeconomic status, race, and limited access to healthcare can increase the likelihood of developing both conditions.

The most common risk factors for hepatitis B and C include sharing drug-use equipment (needles, straws, pipes), unprotected sex, being born in or to someone from a region where the virus is common, and exposure to contaminated medical or personal items. Hepatitis C can also be transmitted through re-used tattooing or piercing tools and, in rare cases, unscreened blood transfusions or organ transplants, especially before 1990 in Canada or more recently in other countries.

Many key risk factors for T2D, such as obesity, non-alcoholic fatty liver disease (NAFLD), and certain social determinants of health, overlap with those for hepatitis B and C, including injection drug use, unprotected sex, and exposure to contaminated equipment; this shared risk environment contributes to a higher co-occurrence of these chronic conditions, especially in marginalized populations.

The Double Burden: Living with Hepatitis and Diabetes

Having both hepatitis and T2D can significantly increase the risk of liver-related and cardiovascular complications.

People with both HCV and diabetes are more likely to develop advanced fibrosis and cirrhosis.
One study found that people with HCV and diabetes had a 3-fold higher risk of hepatocellular carcinoma (HCC) compared to those with HCV alone.
Diabetes can worsen treatment outcomes in patients receiving antiviral therapy for hepatitis.

The liver plays a central role in metabolizing glucose and fats. When hepatitis causes inflammation in the liver, its function can deteriorate, leading to insulin resistance and, ultimately, T2D. Additionally, hepatitis C has been closely associated with insulin resistance, creating a cycle where reduced liver function negatively affects metabolic health.

A Public Health Priority: Why Screening Matters

According to the World Hepatitis Alliance, more than 350 million people worldwide are living with viral hepatitis, and most don’t even know it. Meanwhile, T2D continues to rise globally, affecting more than 537 million adults as of 2021, a number expected to hit 643 million by 2030, according to the IDF.

In Canada, the burden of hepatitis is disproportionately high among certain populations - including people who use drugs, Indigenous communities, newcomers, and individuals in prison. These same groups often face barriers to diabetes care, compounding the risk of poor outcomes.

That’s why integrated care models are essential. These overlapping vulnerabilities point to the need for integrated care. Programs that test and treat for hepatitis should also screen for diabetes - and vice versa. Organizations like CATIE are leading the way in promoting this kind of holistic care approach, recognizing that people don’t experience health conditions in silos.

Clinical Implications

While hepatitis and T2D require distinct treatment plans, integrated care strategies can be beneficial. For instance, direct-acting antivirals (DAAs) for hepatitis C have demonstrated improved metabolic outcomes in patients with T2D. By considering a patient’s overall health, healthcare providers can develop tailored treatment plans.

Clinicians should screen for T2D in people with chronic hepatitis—especially HCV or advanced liver disease.
Hepatitis screening should be considered for people with unexplained liver issues or known diabetes.
Community health programs should combine hepatitis services with diabetes care and harm reduction.
Hepatitis B vaccination is recommended for people with diabetes by public health authorities in Canada and globally.

A New Perspective on Patient Care

The connection between hepatitis and T2D is significant and often underestimated in the Canadian healthcare system. By acknowledging shared risk factors, biological relationships, and understanding clinical implications, healthcare professionals can implement more effective interventions.

As we acknowledge that 28 July is World Hepatitis day, and work toward addressing both hepatitis and T2D, collaboration among healthcare systems, organizations, and communities is essential. Focusing on prevention and early detection in high-risk groups will ultimately lead to better health outcomes for all Canadians.

Recognizing the link between hepatitis and T2D in Canada is vital for countless individuals' health. This understanding can shape a healthier future for our communities and the healthcare system as a whole.

How do you think hepatitis and type 2 diabetes should be addressed in healthcare?