***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Insulin resistance affects  sustained virological response ( SVR ) in chronic hepatitis C. To know whether adding metformin to st and ard antiviral treatment improves SVR , we conducted a prospect i ve , multicentered , r and omized , double-blinded , placebo-controlled trial in 19 Spanish hospitals , including 123 consecutive patients with genotype 1 chronic hepatitis C and insulin resistance . Patients were r and omized to receive either metformin ( arm A ; n = 59 ) or placebo ( arm B ; n = 64 ) in addition to peginterferon alfa-2a ( 180 microg/week ) and ribavirin ( 1000 - 1200 mg/day ) . The primary end point was SVR , and secondary endpoints were viral clearance at weeks 12 , 24 , and 48 , and changes in the homeostasis model assessment ( HOMA ) index over the first 24 weeks . There were no differences between arms at baseline . In the intent-to-treat analysis , SVR was observed in 53 % versus 42 % in arm A and arm B , respectively ( P = NS ) . In the subgroup analyses , SVR was higher in females ( n = 54 ) receiving metformin : arm A , 58 % ( 15/26 ) versus 29 % ( 8/28 ) arm B ( P = 0.03 ) . In the per protocol analysis ( PPA ; n = 101 ) , SVR was 67 % in arm A and 49 % in arm B ( P = 0.06 ) . Viral decline during the first 12 weeks was greater in females receiving metformin : -4.88 ( 1.18 ) versus -4.0 ( 1.44 ) ( P = 0.021 ) , whereas no differences were seen in males . The triple therapy was well tolerated , but diarrhea was more often seen in arm A ( 34 % versus 11 % ; P < 0.05 ) . CONCLUSION Adding metformin to peginterferon and ribavirin was safe and improved insulin sensitivity . Although the study failed to show a statistically significant difference between arms , it did show an improved SVR in females Over a 4-yr period in the northeast region of Japan ( Tohoku ) , 3643 patients for whom a renal biopsy was available were screened . In addition , 2370 biopsied patients for whom hepatitis C virus ( HCV ) serology was available were evaluated . The prevalence of HCV infection was investigated in the 2370 biopsied patients . The highest prevalence of HCV infection was found in type II diabetic-related glomerulosclerosis ( II-DGS ) ( 24 of 123 ; 19.5 % ) . At renal biopsy , clinical and laboratory findings and histologic parameters were comparable between the HCV-positive and -negative II-DGS groups . After renal biopsy , the decline of renal function reflected by the slope of reciprocal serum creatinine ( 1/S(Cr ) ) was significantly greater in the HCV-positive group than in the HCV-negative group ( P = 0.001 ) . The log-rank test performed on the renal survival curves showed a significant difference in the two groups ( P = 0.019 ) . According to a multiple linear regression analysis adjusted for the effect of age , gender , BP , HbA1c , urinary protein excretion , and histologic parameters as covariates , urinary protein excretion ( P = 0.011 ) , severe arteriolar hyalinosis ( P = 0.006 ) , and HCV infection ( P < 0.001 ) were significantly associated with 1/S(Cr ) slope . Finally , HCV infection was r and omly examined in 545 out patients and in patients with type II diabetes mellitus who did not undergo renal biopsy . Of these , 56 patients were positive for HCV antibody ( 10.3 % ) , and their proteinuria was heavier than in 489 HCV-negative patients ( P = 0.001 ) . This study reveals that HCV infection is present at a high rate in type II diabetic-related nephropathy and may have an adverse effect on the progression of the disease BACKGROUND Diabetic patients are at an increased risk of acquiring Hepatitis C virus ( HCV ) infection owing to the nature of the disease and its inherent complications or frequent parentral exposure . On the other h and HCV infection may itself contribute to the development of Diabetes Mellitus . The epidemiological evidence of this association has not been studied in Pakistan at a population level and its exact biological mechanisms are not obvious . Objective of this study was to study the frequency of HCV infection among adult diabetic patients attending the Hospital . METHODS The study comprised of 100 Diabetic patients visiting the out patient clinics or admitted in the medical wards of a Teaching Hospital , in Peshawar . Diabetes was confirmed according to the new diagnostic criteria based on 2 fasting or 2 r and om plasma glucose levels of more than 126 milligram per deciliter ( mg/dL ) and 200 mg/dL respectively . The presence of HCV infection was confirmed by Enzyme Linked Immuno-Sorbent Assay ( ELISA ) method . A concise history of the patient , examination and laboratory findings were recorded on a Performa . RESULTS Out of the hundred diabetics , 36 % were found to be anti HCV positive and all of them had type II diabetes . There was no gender difference in the seropositive cases . Serum Glutamic-Pyruvic Transaminase ( SGPT ) level was raised in 75 % of the positive cases as compared to the 25 % of the seronegative patients . The seropositive cases had a comparatively higher blood sugar level . CONCLUSION HCV infection occurs more often in type II diabetics and further investigations should be done in diabetic patients with raised SGPT for the presence of chronic HCV infection Moderate elevations of serum transaminases are frequently found in patients with diabetes mellitus and are often attributed to fatty infiltration of the liver without further investigation . Recent studies of patients with end-stage liver disease have suggested a possible association between Hepatitis C virus ( HCV ) antibody positivity and the development of diabetes ( mostly Type 2 ) . As a first step in the examination of any potential association between HCV and Type 2 diabetes in subjects without overt liver disease , we examined 200 British patients with Type 2 diabetes ( 100 White Caucasians , 50 Asians , and 50 Afro-Caribbeans ) , recruited from the United Kingdom Prospect i ve Study of Diabetes , half of whom had a significant elevation of alanine aminotransferase ( ALT ) on at least two occasions and half of whom had consistently normal ALT levels .  In Afro-Caribbean Type 2 diabetic subjects 7/25 ( 28 % ) patients with abnormal ALT and 1/25 ( 4 % ) with normal ALT were HCV antibody positive . Among White Caucasian subjects 6/50 ( 12 % ) patients with abnormal LFTs and 0/50 with normal LFTs were HCV antibody positive and in Asians the prevalence was 2/25 ( 8 % ) and 0/25 , respectively . This study suggests that persistent mild to moderate elevation of serum transaminases in a patient with Type 2 diabetes should not automatically be attributed to the metabolic disturbances of diabetes . Particularly in Afro-Caribbean subjects , HCV infection is a major diagnostic consideration . The question of whether HCV infection itself may have a diabetogenic action is worthy of further investigation AIM To assess the prevalence of hepatitis C virus ( HCV ) among Greek patients with Type 1 and 2 diabetes mellitus ( DM ) , in view of the previous reports of high prevalence , particularly in patients with elevated aminotransferase . METHODS We checked 423diabetic patients ( 183 male , 240 female , mean age : 63 years ) attending our unit , recording epidemiology data , diabetes history , treatment and classification . Patients were stratified by aminotransferase values ( normal or elevated ) . HCV screening was performed using st and ard techniques . Statistical analysis was done by using the Student 's t-test for continuous variables and chi-square ( chi2 ) for categorical data . RESULTS Antibodies against HCV ( anti-HCV ) were detected in seven out of 423 diabetic patients ( prevalence 1.65 % ) . There was no correlation between HCV titre and diabetes type , duration , treatment , obesity ( body mass index , BMI ) or glycaemic control ( HbA1c ) . The only correlation was elevated aminotransferase values ( P<0.01 ) Among the established risk factors for HCV transmission , only history of previous transfusion was significant ( P < 0.001 ) . CONCLUSIONS It remains a strong hypothesis that diabetic patients are at increased HCV infection risk , yet our findings in Greek diabetic patients were rather low . Further studies , possibly multicentre , are needed to estimate prevalence and address the question of whether a direct effect of HCV in diabetes development does actually exist 
    Output:
    
Based on the current limited evidence , this study suggests that T2DM is associated with increased susceptibility to HCV infection