Rates and Correlates of Incident Type 2 Diabetes Mellitus Among Persons Living With HIV-1 Infection

Ye, Yuanfan; Shrestha, Sadeep; Burkholder, Greer A.; Bansal, Anju; Erdmann, Nathaniel; Wiener, Howard W.; Tang, Jianming

doi:10.3389/fendo.2020.555401

Cited by 10 publications

(7 citation statements)

References 29 publications

(28 reference statements)

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“…In the overall cohort, older age groups ( southern United States (e.g., Alabama) have found higher incidence of DM among PWH [39]. A similar study conducted recently in Canada among 50 and above age group of PWH with a 13-year follow up period, reported incidence at 16.1 per 1000 person-years [40].…”

Section: Regression Analysismentioning

confidence: 77%

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors

Mohammad Pritom,

Yang,

Gao

et al. 2024

Aids

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Background and objective: The risk factors of diabetes mellitus (DM) in people with HIV (PWH) may be dynamic in a life course manner. This study aimed to describe incidence of DM and investigate the trajectory of changes in risk factor associated with DM incidence over around 15 years among a statewide cohort of PWH in South Carolina (SC). Design: This is a population-based cohort study. Methods: Data were retrieved from the integrated statewide electronic health records between 2006 and 2020 in SC. Separate subgroup analysis was conducted according to the patients’ different follow up duration (i.e., 5, 10, and 15 years) to observe the evolving risk factors of DM development, using multivariable logistic regressions. Results: The DM incidence among a total of 9115 PWH was 8.9 per 1000 person-years. In the overall model, being >60 years old, hypertension, and obesity were positively associated with DM while alcohol consumption, years of HIV diagnosis and high percentage days of viral suppression were negatively associated with the outcome. In the subgroup analyses, similar risk factors were observed. The odds of DM increased in a graded fashion with age. Hypertension was positively associated with DM in all groups and retention to care was negatively associated with the outcome in groups 1 and 3. Conclusion: This large-scale population-based study has revealed a relatively lower incidence of DM among PWH than some other US States. The evolving risk factors over time underline the need for maintaining retention to care to prevent the occurrence of DM.

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Section: Regression Analysismentioning

confidence: 77%

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors

Mohammad Pritom,

Yang,

Gao

et al. 2024

Aids

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“…A study assessing the incidence of and factors associated with DM among people living with HIV in Zimbabwe indicated that those with obesity (BMI ≥30 kg/m 2 ) had approximately 2.5 times the hazard for type 2 DM (T2DM) than those with BMI <30 kg/m 2 [30]. An analysis of retrospective data of people living with HIV attending the 1917 Clinic at University of Alabama at Birmingham, USA, reported that obese people living with HIV (BMI ≥30 kg/m 2 ) had approximately a threefold increased hazard for T2DM than those with BMI <25 kg/ m 2 [31]. The findings from our study, where those with BMI ≥25 kg/m 2 (obese in the Asian classification; overweight in the international classification) were at increased risk of having high FBG, suggest that, irrespective of the BMI classification used, it is important to monitor people living with HIV with elevated BMI.…”

Section: Discussionmentioning

confidence: 99%

BMI as a predictor of high fasting blood glucose among people living with HIV in the Asia‐Pacific region

et al. 2022

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Background Non‐Asian body mass index (BMI) classifications are commonly used as a risk factor for high fasting blood glucose (FBG). We investigated the incidence and factors associated with high FBG among people living with HIV in the Asia‐Pacific region, using a World Health Organization BMI classification specific to Asian populations. Methods This study included people living with HIV enrolled in a longitudinal cohort study from 2003 to 2019, receiving antiretroviral therapy (ART), and without prior tuberculosis. BMI at ART initiation was categorized using Asian BMI classifications: underweight (<18.5 kg/m2), normal (18.5–22.9 kg/m2), overweight (23–24.9 kg/m2), and obese (≥25 kg/m2). High FBG was defined as a single post‐ART FBG measurement ≥126 mg/dL. Factors associated with high FBG were analyzed using Cox regression models stratified by site. Results A total of 3939 people living with HIV (63% male) were included. In total, 50% had a BMI in the normal weight range, 23% were underweight, 13% were overweight, and 14% were obese. Median age at ART initiation was 34 years (interquartile range 29–41). Overall, 8% had a high FBG, with an incidence rate of 1.14 per 100 person‐years. Factors associated with an increased hazard of high FBG included being obese (≥25 kg/m2) compared with normal weight (hazard ratio [HR] = 1.79; 95% confidence interval [CI] 1.31–2.44; p < 0.001) and older age compared with those aged ≤30 years (31–40 years: HR = 1.47; 95% CI 1.08–2.01; 41–50 years: HR = 2.03; 95% CI 1.42–2.90; ≥51 years: HR = 3.19; 95% CI 2.17–4.69; p < 0.001). Conclusion People living with HIV with BMI >25 kg/m2 were at increased risk of high FBG. This indicates that regular assessments should be performed in those with high BMI, irrespective of the classification used.

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“…From the aforementioned analysis, we can conclude that more RCTs need to be done with a comparison of HOMA IR with the other methods (OsGTT, HbA1c). Treating patients with DM is complex due to the progressive nature of the disease ( Gebrie et al, 2021a ; Gebrie et al, 2021b ), and the burden could be higher in HIV comorbidity ( Godman et al, 2020 ; Ye et al, 2020 ; Lopez-Alvarenga et al, 2021 ; Phoswa, 2021 ) that calls for more robust studies in the area.…”

Section: Discussionmentioning

confidence: 99%

HIV Protease Inhibitors and Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

et al. 2021

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Background: Protease inhibitors (PIs) are believed to affect insulin sensitivity. We aimed to analyze the effect of PIs on insulin sensitivity and the onset of diabetes mellitus (DM) in patients with HIV.Methodology: We searched PubMed, Google Scholar, ClinicalTrals.gov, and the WHO International Clinical Trials Registry Platform till November 2020 for randomized controlled trials (RCTs) that studied the effects of PIs on insulin sensitivity and DM in patients with HIV. We followed the PRISMA and PICOS frameworks to develop the search strategy. We used the random-effects meta-analysis model to estimate the mean difference (MD), standardized mean difference (SMD), and risk ratios for our outcomes, using Stata 14 software.Results: We included nine RCTs that enrolled 1,000 participants, with their ages ranging from 18 to 69 years. The parameters and investigations used in the studies to determine insulin sensitivity were glucose disposal rates, hyperglycemia, and mean glucose uptake. The majority of results showed an association between PIs and insulin sensitivity. The pooled analysis showed no statistically significant difference in insulin sensitivity with atazanavir, whether the study was performed on healthy individuals for a short term or long term in combination with other drugs like tenofovir or emtricitabine [SMD = 0.375, 95% CI (0.035, 0.714)]. The analysis showed reduced glucose disposal rates and hence reduced insulin sensitivity with lopinavir (heterogeneity chi-squared = 0.68, I-squared [variation in SMD attributable to heterogeneity] = 0.0%, p = 0.031). The heterogeneity with chi-squared was substantial (61–80%), while with I-squared was not significant (0–40%), p = 0.031). Less adverse events were observed with atazanavir than with lopinavir [RR = 0.987, 95% CI (0.849, 1.124)]. Darunavir and indinavir did not demonstrate any significant changes in insulin sensitivity. Most of the studies were found to have a low risk of bias.Conclusions: There are significant variations in the effects of PIs on insulin sensitivity and onsets of DM. Atazanavir, fosamprenavir, and darunavir did not demonstrate any significant changes in insulin sensitivity, compared to the rest of the group. There is a need to assess the benefits of PIs against the long-term risk of impaired insulin sensitivity. All patients newly diagnosed with HIV should have DM investigations before the start of ARVs and routinely. RCTs should focus on sub-Saharan Africa as the region is worst affected by HIV, but limited studies have been documented.

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Rates and Correlates of Incident Type 2 Diabetes Mellitus Among Persons Living With HIV-1 Infection

Cited by 10 publications

References 29 publications

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors

Examining incidence of diabetes in people with HIV: tracking the shift in traditional and HIV-related risk factors

BMI as a predictor of high fasting blood glucose among people living with HIV in the Asia‐Pacific region

HIV Protease Inhibitors and Insulin Sensitivity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

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