Spotlight on HIV and diabetes

Multiple recent studies focused on patients with HIV and diabetes.

First, a study published by BMJ Open Diabetes Research & Care on Jan. 30 used 2009-2010 data from the Medical Monitoring Project and the National Health and Nutrition Examination Survey to determine the prevalence of diabetes among HIV-infected adults. They found it to be 10.3%, which was 3.8% higher than in the general population after adjustment. Certain subgroups, including women, patients ages 20 to 44 years, and non-obese patients, had particularly higher risk for diabetes compared to similar patients without HIV. Factors associated with diabetes included age, duration of HIV infection, geometric mean CD4 cell count, and obesity. Prescription of antiretroviral therapy (ART) in the past year was not associated with diabetes, the authors noted. The study's results support screening HIV patients for diabetes in accordance with current guidelines and consideration of modifying those guidelines to include HIV infection as a risk factor for diabetes, the study authors said.

Another study, in the February Diabetes Care, compared the effectiveness of HIV medications in veterans with and without HIV (n=2,454 and 8,892, respectively). The study compared response to therapy in patients initiating diabetes therapy with metformin, a sulfonylurea, or a thiazolidinedione between 1999 and 2010. After adjustment, the study found no significant difference in the change in HbA1c by drug class or by HIV status. Black and Hispanic patients had a poorer response to therapy than white patients, a finding that requires further examination into its causes, the authors said. They noted that among patients with HIV, receiving non-protease inhibitor-based ART was associated with better response to diabetes therapy than no ART, but there was no difference between protease inhibitor-based ART and no ART. They recommended clinicians consider factors such as lipid levels, weight, and interactions with ART when selecting a first-line treatment for patients with HIV and diabetes.

Finally, a study published on Jan. 17 by the Journal of Urban Health evaluated the impact of providing a healthy diet of meals and snacks to patients with HIV and/or diabetes. The six-month trial included 23 patients with HIV, 24 patients with type 2 diabetes, and seven patients with both. At baseline, 59.6% of them had very low food security. After six months, that rate had declined to 11.5%. The patients' consumption of fruits and vegetables significantly increased and consumption of fats decreased, as did consumption of sugar among patients with diabetes. Depression and binge drinking also decreased, and there was a trend toward reduced hospitalizations and ED visits among patients with diabetes. The food and packaging costs for this federally funded project were $6.58 per day per participant, the study authors noted. They called for additional projects like this to determine if “medically appropriate food support may reduce societal healthcare costs as well as prevent further impoverishment of critically ill individuals.”