Daniel Faurholt-Jepsen1,2, Mette F Olsen2, Anna B Andersen2, Pernille Kæstel2, Alemseged Abdissa3, Hiwot Amare4, Daniel Yilma3, Tsinuel Girma5, Markos Tesfaye6, Åse B Andersen1, Henrik Friis2, Marit E Jørgensen7,8. 1. Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet. 2. Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark. 3. Jimma University Specialized Hospital. 4. Department of Internal Medicine. 5. Department of Pediatrics and Child Health. 6. Department of Psychiatry, Jimma University, Jimma, Ethiopia. 7. Steno Diabetes Center, Gentofte. 8. National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Abstract
BACKGROUND: Although diabetes is more common in HIV patients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIV patients. METHODS: Among HIV patients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and α1-acid glycoprotein were used as same-day markers of inflammation. RESULTS: Among 332 HIV patients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and α1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference. CONCLUSION: ART-naive Ethiopian HIV patients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIV patients.
BACKGROUND: Although diabetes is more common in HIVpatients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIVpatients. METHODS: Among HIVpatients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and α1-acid glycoprotein were used as same-day markers of inflammation. RESULTS: Among 332 HIVpatients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and α1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference. CONCLUSION: ART-naive Ethiopian HIVpatients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIVpatients.
Authors: Suzanne Filteau; George PrayGod; Andrea M Rehman; Robert Peck; Kidola Jeremiah; Rikke Krogh-Madsen; Daniel Faurholt-Jepsen Journal: Am J Clin Nutr Date: 2021-06-01 Impact factor: 7.045