AUTHOR=Fazekas-Lavu Monika , Tonks Katherine T. T. , Samaras Katherine 

TITLE=Benchmarks of Diabetes Care in Men Living With Treated HIV-Infection: A Tertiary Center Experience

JOURNAL=Frontiers in Endocrinology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2018.00634

DOI=10.3389/fendo.2018.00634

ISSN=1664-2392

ABSTRACT=<p>Treated human immunodeficiency virus (HIV) infection is associated with high rates of type 2 diabetes mellitus (DM), metabolic syndrome and central obesity/body fat partitioning disorders. To our knowledge, there are no available data comparing diabetes care in people with both HIV+DM vs. DM alone (DM-controls) within the same service and evaluating if benchmarked standards of care are being met in people with HIV+DM. This study evaluated the frequency that people with HIV+DM met the benchmarked American Diabetes Association (ADA) standards of care in diabetes (targets for HbA1c, blood pressure, lipid levels, complication screening, and healthy weight), compared to age- and sex- matched controls with diabetes, in an urban teaching hospital. The frequency of diabetes complications and rates of obesity and metabolic syndrome were also examined. All participants were male; individuals with HIV+DM (<italic>n</italic> = 30) were similar to DM-controls (<italic>n</italic> = 30) for age, diabetes duration and smoking status, but were more frequently non-obese compared to DM controls (92 vs. 55%, respectively, <italic>p</italic> = 0.003). Only 41% of HIV+DM met HbA1c targets, compared with 70% of DM-controls (<italic>p</italic> = 0.037). Blood pressure targets were poorly met in both HIV+DM and DM-controls: 43 vs. 23%, respectively (<italic>p</italic> = 0.12); LDL cholesterol targets were met in 65 vs. 67% (<italic>p</italic> = 1.0). Benchmarked complication screening rates were similar between HIV+DM vs. DM-controls for annual foot examination (53 vs. 67%, respectively, <italic>p</italic> = 0.29); biennial retinal examination (83 vs. 77%, respectively, <italic>p</italic> = 0.52); and annual urinary albumin measurement (77 vs. 67%, respectively, <italic>p</italic> = 0.39). The prevalence of diabetes complications was similar between HIV+DM compared to DM-controls: macrovascular complications were present in 23% in both groups (<italic>p</italic> = 1.0); the prevalence of microvascular complications was 40 vs. 30%, respectively (<italic>p</italic> = 0.51). Achieving the standard of care benchmarks for diabetes in people with both HIV-infection and diabetes is of particular importance to mitigate against the accelerated cardiometabolic outcomes observed in those with treated HIV infection. HIV+DM were less likely to achieve HbA1c targets than people with diabetes, but without HIV. People with HIV+DM may require specific strategies to ensure care benchmarks are met.</p>