Comparative Effectiveness of Diabetic Oral Medications Among HIV-Infected and HIV-Uninfected Veterans

Han, Jennifer H.; Gordon, Kirsha S.; Womack, Julie A.; Gibert, Cynthia L.; Leaf, David A.; Rimland, David; Rodriguez‐Barradas, Maria C.; Bisson, Gregory P.

doi:10.2337/dc16-0718

Cited by 14 publications

(11 citation statements)

References 39 publications

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“…Focusing on DM drugs use in our study, it appeared that the treatment regimens were different to those observed in the French general population: 88.6% vs. 43% of patients with DM were on a monotherapy (mostly metformin) in the OVIHD and in the general population, respectively, and only 11.4% of our PLWH with DM were on a combined oral therapy or more recent drugs [ 33 , 46 ]. In a study performed by Han et al in American veterans, 50% of participants received metformin [ 14 ]. Also, some patients were probably controlled on diet alone but we were unable to collect this data.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis, risk factors and management of diabetes mellitus in HIV-infected persons in France: A real-life setting study

et al. 2021

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Background Diabetes mellitus (DM) is a major and increasing public health problem that may be underdiagnosed and undertreated among persons living with HIV (PLWH). Objective To describe the diagnosis, treatment and follow-up of DM among PLWH. Methods This study was performed inside a monocentric cohort of 1494 PLWH. DM was defined as having a FG ≥126 mg/dL twice or a HbA1c ≥6.5%, or a history of diabetes, or receiving antidiabetic treatment. The first visit mentioning a diagnosis of DM was considered as the baseline visit. Chi-Square or Fisher exact test were used to examine the association between categorical variables and DM, Wilcoxon or Student t-test were used for continuous variables. Results 156 PLWH with DM were included. Compared to non-diabetic participants, they were more likely to be native of Sub Saharan Africa (31.6% vs. 22.4%, p = 0.027) and older (54.6 vs. 49.9 years, p<0.001), to have a higher BMI (> 25 for 46.1% vs. 35.3%, p = 0.020) and a poorer control of HIV (HIV RNA<50 copies/mL: 80.1% vs. 89.5%, p<0.001). The diagnosis of DM was missed in 37.8% of PLWH, and 47.2% of PLWH treated for DM did not reach a HbA1c<7%. PLWH with DM were more frequently on antihypertensive and/or lipid-lowering medications: 94.2% had a LDL-cholesterol <70 mg/dL and 60.9% had a blood pressure <140/90 mmHg. Conclusion In a setting of HIV-control, HIV care providers should focus on metabolic issues. The management of DM and associated risk factors is mandatory to prevent cardiovascular disease in PLWH.

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Section: Discussionmentioning

confidence: 99%

“…International guidelines for DM management in PLWH are similar to those in the general population. However, the response to glucose-lowering therapies may be poorer in PLWH as compared to the general population [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Diagnosis, risk factors and management of diabetes mellitus in HIV-infected persons in France: A real-life setting study

et al. 2021

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“…When all HbA1c data are used, different periods of time from initiation of a new agent to measurement may lead to bias. As such, observational studies usually assess outcomes based on a single follow‐up HbA1c at a defined point in time, a mean HbA1c over the follow‐up period or the attainment of glycaemic goal at any time during the follow‐up period . Thus, they provide an estimate of glycaemic control after a specific period post an index treatment.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Kim

Unni

Brixner

et al. 2019

Diabetes Obesity Metabolism

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Aims To identify change in glycated haemoglobin (HbA1c) for 1 year after treatment intensification in patients with HbA1c >53 mmol/mol (7.0%) while on two classes of oral antidiabetic drugs (OADs). Material and methods A retrospective cohort study was conducted using a regional health plan claims database for the period January 1, 2010 to March 31, 2017. Patients with type 2 diabetes (T2DM) whose treatment was intensified with insulin, a glucagon‐like peptide‐1 receptor agonist or a third OAD within 365 days of having HbA1c ≥53 mmol/mol (7.0%) on two OADs were included. The HbA1c trajectory for 1 year after intensification was estimated using a mixed‐effects regression model. Results The analysis included 1226 patients with a mean ± SD HbA1c at treatment intensification of 74.2 ± 18.7 mmol/mol (8.93 ± 1.7%). HbA1c was higher in the insulin group (74.2 mmol/mol) than in the non‐insulin group (70.6 mmol/mol), as was the HbA1c decrease ( P < 0.01) over the 1‐year follow‐up, particularly in patients with baseline HbA1c >9%. After intensification, insulin‐ and non‐insulin‐treated patients achieved an average change by month in HbA1c of −4.7 mmol/mol and −2.6 mmol/mol points, respectively. The analysis predicted HbA1c to be the lowest at 6 to 10 months post intensification, depending on intensification treatment and HbA1c at intensification; however, on average, HbA1c remained above 64.0 mmol/mol (8.0%). Conclusion In patients with T2DM, intensification following an HbA1c value ≥53 mmol/mol (7.0%) while on two OADs was associated with a significant improvement in glycaemic control. Patients intensified with insulin had a higher baseline HbA1c but greater HbA1c reduction than those intensified with a non‐insulin agent. However, HbA1c remained above 64 mmol/mol (8.0%) overall. Additional opportunity exists to further intensify therapy to improve glycaemic control.

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“…However, the impact of traditional risk factors on diabetes development does appear to be more pronounced based on studies evaluating benefits of traditional treatment approaches to Type 2 Diabetes that have reported blunted responses in HIV seropositive patients [ 30 , 46 , 47 ]. These differences may also be related to confounding factors among the HIV positive population and require further investigation [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Immune reconstitution in ART treated, but not untreated HIV infection, is associated with abnormal beta cell function

et al. 2018

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HIV infection has been associated with increased diabetes risk, but prior work has mostly focused on insulin resistance, as opposed to beta cell effects, or included patients on antiretroviral therapies (ART) directly linked to metabolic toxicity. In this analysis, we measured markers of glucose homeostasis and beta cell function, stress, and death in fasting sera from a cross section of HIV+ individuals off ART (n = 43), HIV+ individuals on ART (n = 23), and HIV- controls (n = 39). Markers included glucose, HOMA%S, HOMA%B, proinsulin:C-peptide ratio (PI:C ratio), and circulating preproinsulin (INS) DNA. We performed multiple linear regressions with adjustments for age, sex, race, BMI, and smoking status. Compared to HIV- controls, HIV+ participants off ART exhibited similar beta cell function and insulin sensitivity, without increases in markers of beta cell stress or death. Specifically, in HIV+ participants with CD4 counts <350 cells/μL, PI:C ratios were lower than in HIV- controls (p<0.01), suggesting a reduction in intrinsic beta cell stress among this group. By contrast, HIV+ participants on ART had higher fasting glucose (p<0.0001) and lower HOMA%B (p<0.001) compared to HIV- controls. Among the entire HIV+ population, higher HIV RNA correlated with lower fasting glucose (r = -0.57, p<0.001), higher HOMA%B (r = 0.40, p = 0.001), and lower PI:C ratios (r = -0.42, p<0.001), whereas higher CD4 counts correlated with higher PI:C ratios (r = 0.2, p = 0.00499). Our results suggest that HIV seropositivity in the absence of ART does not worsen beta cell function or glucose homeostasis, but immune reconstitution with ART may be associated with worsened beta cell function.

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Comparative Effectiveness of Diabetic Oral Medications Among HIV-Infected and HIV-Uninfected Veterans

Cited by 14 publications

References 39 publications

Diagnosis, risk factors and management of diabetes mellitus in HIV-infected persons in France: A real-life setting study

Diagnosis, risk factors and management of diabetes mellitus in HIV-infected persons in France: A real-life setting study

Longitudinal changes in glycated haemoglobin following treatment intensification after inadequate response to two oral antidiabetic agents in patients with type 2 diabetes

Immune reconstitution in ART treated, but not untreated HIV infection, is associated with abnormal beta cell function

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