Interferon Alpha Induced Diabetes Mellitus

Presentation Number: SAT 625
Date of Presentation: April 1st, 2017

Lubna Bashir Munshi*1, Simeng SUN1, Jose Gonzalo Sanchez1 and Zijian Chen2
1Mount Sinai Beth Israel, New York, NY, 2Mount Sinai Diabetes Center, New York, NY

Abstract

Background:

Interferons are proteins within the cytokine family that are produced by WBCs in response to viral infections. Interferon alpha is used for the treatment of hepatitis B and C and certain malignancies. The use of interferon alpha can lead to the development of autoimmune diseases such as diabetes and hypothyroidism. Interferon-alpha has also been shown to exacerbate preexisting autoimmune endocrine diseases. Although the use of interferon therapy for chronic hepatitis C has decreased in recent years, it is still being used for hairy cell leukemia, follicular lymphoma, melanoma, AIDS-related Kaposi sarcoma and condyloma acuminata. Thus, physicians have to be aware that diabetes can be a consequence of the treatment with Interferon alpha.

Case:

We present a case of 62 year old male patient with past medical history of hepatitis C, first diagnosed in 1987. He received interferon alpha treatment from 2007 to 2008. In 2009 he was diagnosed with diabetes mellitus after he had symptoms of polydipsia, polyuria and was found to have hyperglycemia. At the time of diagnosis his C-peptide level was undetectable 2 hours after administration of 50g of glucose. The concurrent blood glucose was 465 mg/dL. He was started on basal and bolus insulin, but he had frequent episodes of symptomatic hypoglycemia. In 2012 he was switched to a Medtronic insulin pump. Currently, his diabetes is fairly well controlled on the insulin pump with a recent hemoglobin A1c of 7.5.

Discussion:

The use of interferon alpha has been associated with development of diabetes, yet the exact mechanism is still not clear. Interferons have shown to play a role in autoimmunity by activating macrophages, cytotoxic T-cells and natural killer cells, which can lead to pancreatic beta cell destruction. Interferon-alpha can also induce increased levels of interleukin-1, which can be cytotoxic to pancreatic cells. Interferon-alpha can also cause insulin resistance by up regulating counter-regulatory hormones such as glucagon, growth hormone and cortisol. In a study done by Stewart et al., diabetes was prevented in transgenic mice overexpressing interferons in pancreatic islet cells with anti-interferon antibodies. For patients with history of insulin dependent diabetes, increased insulin requirement during or after interferon alpha treatment may suggest pancreatic islet cell destruction.

Conclusion:

With the emergence of new drugs treatment options for hepatitis C, the use of interferon alpha has decreased however it is still used in resistant cases and also for some other disease states. Thus, physicians need to be mindful of the side effects of interferon alpha and monitor for hyperglycemia post treatment especially in those with high risk of developing diabetes.

 

Nothing to Disclose: LBM, SS, JGS, ZC