Increased Insulin Resistance Following Praziquantel Treatment in Human Opisthorchiasis Caused by Opisthorchis Viverrini Infection

Abstract

Opisthorchiasis caused by Opisthorchis viverrini (OV) infection is a significant public health issue in Northeast Thailand, where the incidence of type 2 diabetes mellitus (T2DM) exceeds national averages. Recent studies have indicated hyperglycemia following praziquantel (PZQ) treatment for opisthorchiasis, however, the underlying mechanism remains unclear. To explore this further, we conducted a prospective, one-year follow-up study of 110 patients treated for opisthorchiasis. Blood samples were collected to assess fasting blood glucose (FBG), oral glucose tolerance test (OGTT), and serum insulin levels (SIL). Demographic data, including body mass index (BMI) and other diabetes risk factors, were also analyzed. The study revealed a significant increase in FBG after 12 months of PZQ treatment (87.43±0.97 vs. 92.39±1.73, P=0.010). Likewise, both SIL and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) showed significant post-treatment increases (9.64±0.67 vs. 13.35±1.07, P=0.003; 2.10±0.15 vs. 3.04±0.25, P=0.001, respectively). A general linear model identified age over 50 (P=0.041) and baseline obesity (P=0.007) or overweight status at follow-up (P=0.021) as significant factors associated with elevated FBG, while sex, smoking, alcohol consumption, and family history were not. HOMA-IR was significantly associated with underweight status (P<0.05), though no independent factors were linked to SIL. OGTT results did not differ significantly before and after PZQ treatment (P>0.05), but they were associated with female sex (P<0.001), alcohol consumption (P=0.035), and baseline obesity (P=0.027). These findings suggest that the removal of liver flukes may increase insulin resistance in opisthorchiasis patients, potentially elevating their risk of developing T2DM following PZQ treatment.

Note:
Funding declaration: This research was supported from the Fundamental Fund of Khon Kaen University (KKU), which has been funded by the National Science, Research, and Innovation Fund (NSRF) (Grant ID: 65A1030000074) and Khon Kaen University Research Plan (grant # RP64018). HK was supported by the Faculty of Medicine scholarship.

Conflict of Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical Approval: This study was approved by the Khon Kaen University Ethics Committee for Human Research (KKUEC), reference number HE631445. Informed consent was obtained from all participants prior to their involvement.

Keywords: Opisthorchis viverrini, hyperglycemia, insulin resistance, Diabetes, T2DM, praziquantel