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Association between self-monitoring of blood glucose and hepatitis B virus infection among people with diabetes mellitus: a cross-sectional study in Gansu Province, China
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  • Published on:
    Responses to critical remarks by Sarosh A. Khan
    • Bingfeng Han, Doctorial student Department of Epidemiology and Biostatistics, Peking University School of Public Health
    • Other Contributors:
      • Fuqiang Cui, Professor

    As early as 2011, Advisory Committee on Immunization Practices (ACIP) in the US recognized the high risk of hepatitis B infection in diabetic patients and recommended that all previously unvaccinated adults aged 19 through 59 years with diabetes mellitus (type 1 and type 2) be vaccinated against hepatitis B as soon as possible after a diagnosis of diabetes is made[1]. Based on more evidence, the hepatitis B vaccine position paper revised by the WHO in 2017 highlighted that the population with diabetes is at high risk of HBV infection[2]. In 2019, a guideline published by Chinese Medicine Association highlighted for the first time that the diabetic population is at high risk of HBV infection and recommended hepatitis B vaccination in China[3]. Many studies identified the high risk of hepatitis B infection in diabetic patients[4-6], however, some surveys showed that no association of HBsAg with the presence of diabetes[7,8].
    A cross-sectional study can describe the epidemiological characteristic of hepatitis B virus (HBV) infection among diabetes, however it cannot provide evidence of causality. In this study[9], we focused on the differences of HBV infection among diabetic patients compared with health people, and then analyzed the potential factors to imply possible infection pathways. When designing this study, we paid more attention to the situation of individuals, including demographic characteristics and frequency of monitoring blood glucose. We took individuals...

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    Conflict of Interest:
    None declared.
  • Published on:
    Diabetes and SMBG per se do not increase the risk of Hepatitis B.

    Thanks for the paper on an important topic of immense significance. However, the paper does not tell us the following:
    1. How many patients with diabetes were sharing the glucometers?
    2. How many patients with diabetes were sharing insulin needles?
    3. How many in the same family had diabetes?
    4. How many in the family of these patients with diabetes had a family member carrying HBsAg?
    China having the highest number of patients with HBsAg carrier state means one has to be extra-cautious while using glucometers and changing the lancets every single time. Also making sure to use disposable syringes or at least not sharing the insulin syringes. Moreover all members of a diabetic patient should be screened for HBsAg. And all diabetic patients should get HB vaccination.
    The conclusion that "Routine blood glucose monitoring at home was associated with HBV infection, which meant people with diabetes may be at high risk of HBV infection" is misleading. It is the sharing of contaminated lancets and needles which are responsible.
    Lastly question B1 in the Appendix A is hilarious.

    Conflict of Interest:
    None declared.