Association between Herpes Simplex Virus Type 1 and Type 2 with Prevalent Diabetes Mellitus Among the US Adults: Findings from the National Health and Nutrition Examination Survey, 2007-2016

Background:Infectious diseases are associated with an increase in the risk of developing insulin resistance and subsequent diabetes mellitus due to a possible role of chronic inflammation. While this relationship is well established for viral infections like hepatitis C or hepatitis B, little is known about the association of herpes simplex virus type 1 (HSV-1) and herpes simplex virus type 2 (HSV-2) with diabetes mellitus. Methods: We conducted a cross-sectional study using the data from the 2007-2016 cycle of the National Health and Nutrition Examination Survey. Participants from the age group of 18-49 years with valid diabetes mellitus and HSV-1 and HSV-2 results and who completed the interview and examination were eligible for the analysis. HSV-1 and HSV-2 were defined by type specific enzymatic immunodot assay as positive or negative. Diabetes status was defined by glycohemoglobin level (HbA1c) as euglycemic (≤5.6%), prediabetes (5.7-6.4%), and diabetes (≥6.5%); participants who self-reported being diabetic were considered as having diabetes regardless of their HBA1c levels. We conducted logistic regression analysis to estimate the crude and adjusted odds ratio and 95% confidence interval of diabetes mellitus comparing participants with positive HSV-1 and HSV-2 to those with negative HSV-1 and HSV-2. Results: The prevalence of HSV-1 among participants with diabetes was 67.2% (95% CI 62.3,72.0), and the prevalence of HSV-2 among participants with diabetes was 26.9% (95% CI 23.2,30.7). The prevalence of diabetes among participants with HSV-1 infection was 5.7% (95% CI 5.1,6.3), and the prevalence of diabetes among HSV-2 infection was 7.9% (95% CI 6.8,8.9). After adjusting for confounding factors, the odds of diabetes versus euglycemia among participants with HSV-1 was 1.05 (95% CI 0.9,1.2), and odds of diabetes versus euglycemia among participants with HSV 2 was 1.1 (95% CI 0.9,1.2). Conclusion: After controlling for potential confounders, HSV-1 and HSV-2 infections are not associated with diabetes mellitus in the US population aged 18-49 years, 2007-201