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Higher Diabetes Rate in People With HIV Highlights Importance of Prevention and Monitoring

July 13, 2017

One in 10 Americans being treated for HIV may also be living with diabetes, according to the results of a large study. The diabetes rate was about 4% higher in people with HIV than in the general U.S. population, and people with HIV acquired diabetes at an earlier age than HIV-negative people -- highlighting the importance of early monitoring for and prevention of diabetes.

Diabetes -- high sugar levels in blood -- affects 29 million people in the United States. As people live longer with HIV thanks to antiretroviral therapy, they run a greater risk of diabetes, which can lead to heart disease, kidney disease, blindness and death.

People can lower their diabetes risk by (1) avoiding becoming overweight or obese, (2) controlling high blood pressure, (3) maintaining healthy levels of "good cholesterol" and triglycerides, (4) staying physically active and (5) getting treatment for depression.

U.S. researchers conducted this new study to estimate the diabetes rate (prevalence) in an HIV group that represents the entire U.S. HIV population. They then compared this estimate to the diabetes rate in a countrywide sample of people without HIV.

The study focused on two large groups: the Medical Monitoring Project (MMP) of people with HIV infection and the National Health and Nutrition Examination Survey (NHANES) of the general population. The study period for both groups was 2009-2010, and everyone was 20 years old or older. The researchers checked MMP and NHANES records to see how many people had diabetes in the study period. To compare diabetes rates in people with versus without HIV, the investigators used a statistical method that accounts for the impact of age, sex, race and other factors on diabetes risk.

There were 8610 people in the HIV group (74% of them men) and 5604 in the general population group (49% of them men). Most people in the HIV group (90%) were taking antiretroviral therapy. Almost three-quarters had a viral load below 200 copies/mL, and almost half had a CD4 count at or above 500 cells/mm3.

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The overall diabetes rate was higher in people with than without HIV: 10.3% versus 8.3%. When the researchers accounted for the impact of age, sex and other diabetes risk factors, they determined that the diabetes rate was 3.8% higher in the MMP HIV group than in the NHANES general population. In most subgroups analyzed, people with HIV had a higher diabetes rate than people without HIV, including women (5% higher with HIV), men (2.4% higher), whites (4.9% higher), people 20 to 44 years old (4.1% higher), people 45 to 60 years old (3.9% higher), obese people (4.4% higher) and nonobese people (3.5% higher). All these differences between the HIV group and the HIV-negative group were statistically significant, meaning the difference cannot be explained by chance.

Analysis limited to people with HIV determined that the diabetes rate was highest in people 60 years old or older (19.6%), with obesity (18.9%), with a lowest-ever CD4 count above 500 cells/mm3 (13.5%), with an HIV diagnosis for more than 10 years (12.3%) and with hepatitis C coinfection (11.6%). This analysis identified four factors independently linked to a higher diabetes rate in people with HIV: older age, obesity, longer time with HIV and higher CD4 count in the past 12 months.

The researchers underlined the higher diabetes rate with HIV in two groups that usually have a relatively low diabetes risk: people who are not obese and people 20 to 44 years old. Those findings suggest that the HIV group "may be more likely to have diabetes ... at younger ages and in the absence of obesity compared with the general U.S. adult population."

The research team advised HIV providers to follow guidelines that recommend measuring fasting blood glucose and hemoglobin A1c before and after starting antiretroviral therapy. And as previously noted, people with HIV can lower their diabetes risk by maintaining a healthy weight, exercising, maintaining healthy cholesterol and blood pressure levels, and getting treatment for depression. The National Institute of Diabetes and Digestive and Kidney Diseases also offers an online diabetes risk test.

Mark Mascolini writes about HIV infection.


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