Targets for the management of diabetes are as likely to be achieved in HIV-positive as HIV-negative individuals, US investigators report in the September 1st edition of Clinical Infectious Diseases.
Diabetes affects an estimated 8% of adults in the US. Insulin resistance is highly prevalent amongst HIV-positive individuals and research suggests that the incidence of diabetes is five time greater amongst patients with HIV than amongst the general population.
Caring for patients with diabetes is complex and requires contributions from a number of specialists. However, there is little research looking at the standard of care provided to HIV-positive individuals with diabetes.
Investigators from Chicago therefore designed a retrospective study to determine the proportion of HIV-positive patients with diabetes who achieved the goals of the American Diabetes Association (ADA).
A total of 216 patients were included in the study, and were all recruited from the Ruth M. Rothstein Core Center.
Guidelines issued by the ADA in 2008 set the following goals for patients with the disease:
- Haemoglobin A1c below 7%.
- Blood pressure below 130/80 mm Hg.
- Total cholesterol below 200 mg/dl.
- LDL cholesterol below 100 mg/dl.
- Triglycerides below 150 mg/dl.
- HDL cholesterol above 40 mg/dl in men and 50 mg/dl in women.
All the patients included in the study had had at least two follow-up appointments in the previous twelve months. Diabetes was diagnosed a median of three years after HIV infection.
Lipid levels were monitored at least once in 96% of patients.
Mean haemoglobin A1c was 7.3%, with 54% of patients achieving the target of below 7%.
Approximately 75% of patients achieved the target total cholesterol level, 58% the LDL-cholesterol level, 50% the HDL-cholesterol level, and 55% the ideal blood pressure. However, fewer than 40% of individuals achieved the triglycerides target. These results are comparable to those seen in the general US population.
Men were somewhat more likely than women to meet the haemoglobin and cholesterol targets, whereas more women than men achieved ideal triglyceride and blood pressure values.
A nutritionist was seen by 70% of patients, and 18% of patients had a foot examination.
On the basis of their review, the investigators make three recommendations about how to improve care for HIV-positive patients with diabetes.
- Checklists for patients would be useful, with the timing of appropriate tests and examinations flagged.
- Improve patient education regarding nutrition, foot care, glucose monitoring, the use of other medications and general disease management.
- Experts in the care of diabetes should provide annual updates to clinical staff specialising in HIV care.
“We found that HIV-infected diabetic patients in our clinic achieved ADA goals at similar rates to those reported from HIV-uninfected diabetic patients in general medical clinics”, comment the investigators. They note that desired lipid levels are hard to achieve, probably because some antiretroviral drugs can increase blood fats. As diabetic patients have an increased risk of cardiovascular disease, the investigators recommend that “lipid levels should be managed aggressively”.
The researchers conclude, “a multidisciplinary approach to care is needed to improve disease outcomes in this patient population.”
Adeyemi O et al. Are we meeting the American Diabetes Association goals for HIV-infected patients with diabetes mellitus?. Clin Infect Dis (online edition), 2009.