Glycemic control in HIV-infected patients with diabetes mellitus and rates of meeting American Diabetes Association management guidelines.

Abstract

Limited data exist on the prevalence of inadequate glycemic control and rates of meeting American Diabetic Association (ADA) management guidelines in HIV-infected adults with diabetes mellitus. We conducted a retrospective cross-sectional study of 142 HIV-infected adults with type 2 diabetes at an urban academic HIV clinic during 2008. We estimated the prevalence of and assessed associations with inadequate glycemic control, defined as hemoglobin A(1c) ≥ 7.5% for ≥ 50% of quarters over the year, and determined rates of meeting ADA clinical goals. Ninety-two percent of patients received antiretroviral therapy. The prevalence of inadequate glycemic control was 33% (95% confidence interval [CI] 25%-42%). Compared to patients with adequate control, those with inadequate control had fewer years since HIV diagnosis (12.7 versus 15.1, p = 0.01), increased use of insulin (60% versus 20%, p < 0.001) or any diabetic medication (98% versus 85%, p = 0.02), and higher triglyceride levels (238 versus 168 mg/dL, p = 0.008). Rates of achieving ADA goals were 42% for blood pressure, 66% for low-density lipoprotein cholesterol (LDL-C), 33% for high-density lipoprotein cholesterol, and 31% for triglycerides. Thirty-six percent of patients who did not meet the LDL-C goal received statin therapy. Forty-seven percent of patients were screened for retinopathy and 19% of patients without preexisting renal disease were screened for nephropathy. In conclusion, the prevalence of inadequate glycemic control in HIV-infected patients with diabetes is similar to published data from the general population. Suboptimal rates of meeting ADA blood pressure and lipid goals and adherence to screening guidelines demonstrate need for further clinician and patient education.