Diabetes in Patients With HIV: Patient Characteristics, Management and Screening

Neth J Med. 2015 Aug;73(7):310-5.

Abstract

Background: As HIV management has become more successful during the past years, non-communicable diseases have become more prevalent among HIV-infected individuals. As a result, more HIV-infected patients die of cardiovascular diseases, with diabetes being one of the main risk factors. This study evaluates screening and management of diabetes among HIV-infected patients in a university hospital in the Netherlands.

Methods: We examined clinical characteristics, glycaemic control and cardiovascular risk management of HIV-infected patients with coexisting diabetes, and determined the frequency of diabetes screening in those without.

Results: Of 518 HIV-infected patients, 28 had been diagnosed with diabetes (5.4%), mostly (20÷28) after being diagnosed with HIV. Patients with coexisting diabetes were older, had a longer duration of HIV, lower CD4 cell counts and higher body mass index (BMI), and were more likely to use aspirin, statins and antihypertensive medication than those without diabetes (all p < 0.05). HbA1c values were below 7% (53 mmol÷mol) in 54% of patients. Targets for systolic blood pressure (< 140 mmHg), LDL cholesterol (< 2.5 mmol÷l) and BMI (< 25 kg÷m2) were achieved by 82%, 50% and 29% of patients, respectively. Annual ophthalmology examination, screening for microalbuminuria and foot control were rarely performed. Among the patients without known diabetes, diabetes screening during the past year had been performed using (non-fasting) plasma glucose in 56% and HbA1c in 10%, but 42% of patients had not been screened.

Conclusion: For HIV-infected individuals with diabetes, glycaemic control and cardiovascular risk management were reasonable, but screening for microvascular complications was rarely performed. Annual diabetes screening of HIV-infected patients was not routine.

MeSH terms

  • Adult
  • Age Factors
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 1 / drug therapy
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / drug therapy
  • Dyslipidemias / complications
  • Dyslipidemias / drug therapy
  • Female
  • Glycated Hemoglobin A / metabolism
  • HIV Infections / complications*
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy
  • Hypoglycemic Agents / therapeutic use*
  • Male
  • Mass Screening / methods
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Netherlands
  • Retrospective Studies

Substances

  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human