{"id":36125,"date":"2019-05-20T08:38:32","date_gmt":"2019-05-20T08:38:32","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=36125"},"modified":"2019-05-28T10:56:28","modified_gmt":"2019-05-28T10:56:28","slug":"type-2-diabetes-is-often-undermanaged-in-hiv-positive-people","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/36125","title":{"rendered":"Type 2 diabetes is often undermanaged in HIV positive people"},"content":{"rendered":"<p class=\"HTBsubhead3authorcredit\"><strong><span lang=\"EN-US\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-36009\" src=\"https:\/\/i-base.info\/htb\/wp-content\/uploads\/2019\/04\/logo-bhiva-2019-text-300x240.png\" alt=\"\" width=\"221\" height=\"155\" \/>Simon Collins, HIV i-Base<\/span><\/strong><\/p>\n<p class=\"HTBBODYtext\"><strong><span lang=\"EN-US\">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.<\/span><\/strong><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">This poster was presented by Qingwei Zhang from Imperial College and colleagues from the Chelsea and Westminster Hospital, London.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Of these 256 patients, 88% were men and 47% were white British.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">HIV characteristics included median CD4 count 637 cells\/mm<sup>3\u00a0<\/sup>and 85% had viral load &lt;20 copies\/mL.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">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%.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">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%).<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Comorbidities were very common including cardiovascular disease (54%), dyslipidaemia (17%) and chronic kidney disease (17%).<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">Diabetic medication included multiple treatments for many patients: metformin (62%), sulphonyureas (31%), insulin (25%) peptide analogues (17%) and 15% were on diet-control only.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">However, almost half this cohort (48%) were not meeting NICE blood pressure targets.<\/span><\/p>\n<ul>\n<li class=\"HTBBODYtext\"><span lang=\"EN-US\">70% did not have LDL-cholesterol within range.<\/span><\/li>\n<li class=\"HTBBODYtext\"><span lang=\"EN-US\">Only 23% were having HbA1c levels checked every 6 months.<\/span><\/li>\n<li class=\"HTBBODYtext\"><span lang=\"EN-US\">Less than half (48%) had protein:creatinine ratio (uPCR) checked annually.<\/span><\/li>\n<li class=\"HTBBODYtext\"><span lang=\"EN-US\">Only 4% had albumin:creatinine (uACR) checked annually.<\/span><\/li>\n<\/ul>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">This study concluded that access to updated treatment (SGLT-2 inhibitors) and better communication with GPs was needed.<\/span><\/p>\n<p class=\"HTBBODYtext\"><span lang=\"EN-US\">As a result of the audit, the hospital also established a specialist metabolic HIV clinic.<\/span><\/p>\n<h3>comment<\/h3>\n<p><strong>The new HIV metabolic outpatient service is a cross directorate outpatient clinic once a month for all patients with HIV and complex metabolic comorbidities. <\/strong><\/p>\n<p><strong>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.<\/strong><\/p>\n<p><strong>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.<\/strong><\/p>\n<p class=\"HTBreference-noindent\"><span lang=\"EN-US\">Reference<br \/>\n<\/span>Zhang Q et al. Audit of type 2 diabetes in people living with HIV: performance against NICE guidelines targets. BHIVA 2019. Poster abstract P053.<br \/>\n<a href=\"https:\/\/www.bhiva.org\/file\/5ca73250c5137\/P053.pdf\" rel=\"noopener\">https:\/\/www.bhiva.org\/file\/5ca73250c5137\/P053.pdf<\/a> (PDF)<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Simon Collins, HIV i-Base 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 &hellip;<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,8,27,31],"tags":[265],"class_list":["post-36125","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-side-effects","category-weight-diabetes-metabolic-complications","category-opportunistic-infections-coinfections-and-complications","tag-bhiva-2019"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/36125","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=36125"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/36125\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=36125"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=36125"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=36125"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}