1. Home>
2. Specialties>
3. HIV/AIDS Clinical Care>
4. Summary and Comment

Diabetes Care in HIV-Infected Patients

In a single-center, cross-sectional study, more than half of the HIV-infected patients with diabetes met the 2008 ADA goals for hemoglobin A_1c levels, blood pressure, and lipid levels.

Type 2 diabetes is relatively common among HIV-infected people in the U.S., but how well is it being managed? One way to assess this is to evaluate the proportion of HIV-infected patients with diabetes who have achieved the management goals set by the American Diabetes Association (ADA). Researchers did just that at a large HIV clinic in Chicago.

Using ICD-9 codes, laboratory data, and pharmacy records, the researchers identified

216 HIV-infected patients with diabetes who were seen at the clinic at least twice during a 1-year period. Most were male, black, and had well-controlled HIV infection. On average, diabetes was diagnosed 3 years after diagnosis of HIV infection. Almost all the patients (98%) were receiving potent combination antiretroviral therapy, with 43% taking PIs.

Most patients achieved the ADA management goals. For example, 54% had hemoglobin A_1c levels <7%, 56% had blood pressure <130/80 mm Hg, and 72% had total cholesterol levels <200 mg/dL.

Comment: This study is an encouraging first step in evaluating the quality of diabetes management in HIV-infected patients. Although the authors suggest that these results are comparable to or better than those seen in the general population, this conclusion may be premature. The single most influential factor in controlling HbA_1c levels is the HbA_1c level at diagnosis. Because these patients were already in care for their HIV infection when their diabetes was diagnosed, they presumably had relatively low HbA_1c levels at diagnosis, compared with the general population. This would also be true for cholesterol levels and blood pressure. In addition, obesity can contribute to difficulty achieving the ADA goals, and the prevalence of overweight and obesity in this cohort was lower than that in the general population. Finally, medication adherence and care by an endocrinologist can also influence the likelihood of adequate diabetes management, and neither of these factors was considered in the study. Clearly, we would need a comparison that controls for some of these important factors before concluding that diabetes management is as good or superior to that provided in the general population.

— Nancy Kim, MD, PhD, and Amy C. Justice, MD, PhD

Dr. Kim is Instructor, Section of General Internal Medicine, Yale School of Medicine. Dr. Justice is Associate Professor of Medicine, Yale School of Medicine, and Chief of General Medicine, VA Connecticut Healthcare System.

Published in AIDS Clinical Care September 21, 2009

Citation(s):

Adeyemi O et al. Are we meeting the American Diabetes Association goals for HIV-infected patients with diabetes mellitus? Clin Infect Dis 2009 Sep 1; 49:799.

• Medline abstract (Free)