High incidence and risk factors for diabetes in French cohort

31 December 2009. Related: Conference reports, Lipodystrophy Workshop (IWADRW) 11 Philadelphia 2009.

Simon Collins, HIV i-Base

The incidence of diabetes and related risk factors from the ANRS C08 APROCO-COPILOTE cohort was presented by Jacqueline Capeau. [1]

The cohort included 643 patients on their first protease inhibitor-based regimen, followed from 1997-8 for nine years, 40% of who were ARV-naive when the study started. Approximately 80% were male and 4,500 patient years of follow-up (PYFU) contributed to the analysis.

Diabetes was diagnosed as fasting glycaemia >7.0 mmol/L or 2-hour oral glucose tolerance test (OGTT) >11.1 mmol/L and/or treatment for diabetes.

Cardiovascular risk was calculated using Framingham.

The group reported a high incidence of diabetes in both men (10.8 per 1000 PYFU; 95%CI: 7.9-14.3) and women (11.4; 9%CI: 5.7-20.3). After adjusting for family history, age, BMI and waist:hip ratio, the following factors were associated with new onset diabetes: age > 40 years, BMI >25, WHR >0.97 in men and >0.92 in women and use of d4T or indinavir. HIV-related markers including CD4, CD4:CD8 ratio, viral load, ethnicity and HCV status were not associated.

When compared to patients with normal glycaemic function, people with diabetes were older (median 43 vs 35 years), had higher BMI (median 24 vs 21), had higher rates of hypertension (50% vs 18%) and family history of diabetes (37% vs 16%), all p<0.001.

Diabetic patients also had a significantly higher 10-year cardiovascular risk (13% vs 3%).

The researchers commented that these rates were four times higher than in HIV-negative control cohort with similar adipose profile. [2]

COMMENT

The study hasn’t so far found that impaired glucose tolerance has predicted development of diabetes. Over time the incidence of new cases appears to have levelled out, perhaps relating to reduced use of d4T and ddI. Naive patients using neither of these RTIs seem to be protected, although further analyses are needed to see whether levels remain higher than in the general population.

References

1. Capeau J et al. High incidence and risk factors for diabetes over the 9-year follow-up after first generation protease inhibitors’ initiation in the ANRS C08 APROCO-COPILOTE cohort. 11th Intl Workshop on Adverse Drug Reactions. 26-28 October 2009, Philadelphia. Oral abstract O-05. Antiviral therapy 2009; 14 Suppl 2: A5.
2. Meisinger C et al. Sex differences in risk factors for incident Type 2 Diabetes Mellitus: the MONICA Augsburg Cohort Study. Arch Intern Med 2002; 162: 82-89. ’http://archinte.ama-assn.org/cgi/content/abstract/162/1/82