Type 2 diabetes is often undermanaged in HIV positive people
20 May 2019. Related: Conference reports, Side effects, Lipodystrophy and metabolic complications, Coinfections and complications, BHIVA 25th Bournemouth 2019.
A retrospective review of patient notes (up to December 2015) from a large London HIV clinic reported prevalence of type 2 diabetes mellitus (T2DM) of 3% (256/9131 patients) and that approximately half were not achieving NICE-recommended blood pressure targets.
This poster was presented by Qingwei Zhang from Imperial College and colleagues from the Chelsea and Westminster Hospital, London.
Of these 256 patients, 88% were men and 47% were white British.
HIV characteristics included median CD4 count 637 cells/mm3 and 85% had viral load <20 copies/mL.
Current ART (in 2015) included commonly used combinations including darunavir/r (35%), efavirenz (23%) and raltegravir (20%). NRTI backbone was TDF/FTC in 33% and abacavir/3TC in 15%.
Many of these people had been HIV positive for many years and historical ART included AZT (38%), d4T (33%), ddI (29%), saquinavir (13%) and indinavir (7%).
Comorbidities were very common including cardiovascular disease (54%), dyslipidaemia (17%) and chronic kidney disease (17%).
Diabetic medication included multiple treatments for many patients: metformin (62%), sulphonyureas (31%), insulin (25%) peptide analogues (17%) and 15% were on diet-control only.
However, almost half this cohort (48%) were not meeting NICE blood pressure targets.
- 70% did not have LDL-cholesterol within range.
- Only 23% were having HbA1c levels checked every 6 months.
- Less than half (48%) had protein:creatinine ratio (uPCR) checked annually.
- Only 4% had albumin:creatinine (uACR) checked annually.
This study concluded that access to updated treatment (SGLT-2 inhibitors) and better communication with GPs was needed.
As a result of the audit, the hospital also established a specialist metabolic HIV clinic.
The new HIV metabolic outpatient service is a cross directorate outpatient clinic once a month for all patients with HIV and complex metabolic comorbidities.
A live well pathway also links to dietician and physiotherapy services as part of a holistic approach to care that includes support for lifestyle modifications in order to prevent and reduce the long term cardiovascular risks.
The prevalence of both diabetes and dyslipidaemia in the Chelsea and Westminster study is likely to be underestimated due to limitations of electronic patient records in this database.
Zhang Q et al. Audit of type 2 diabetes in people living with HIV: performance against NICE guidelines targets. BHIVA 2019. Poster abstract P053.