Importance of hepatitis C virus-associated insulin resistance: Therapeutic strategies for insulin sensitization

Figure 1 Pathogenic mechanisms and therapeutic strategies for hepatitis C virus (HCV)-associated insulin resistance. Black squares indicate therapeutic strategies for HCV-associated insulin resistance. Proper diet, exercise, iron restriction, phlebotomy, and coffee intake are recommended to any stage of liver disease. In cirrhotic patients, a late evening snack (LES), branched-chain amino acid (BCAA) supplementation, and a zinc supplement are also recommended. Insulin-sensitizing agents can be used in patients with chronic hepatitis C, however, the agents are not always recommended for patients with liver cirrhosis because of severe adverse effects.