Around a third of people living with HIV receiving care at three large HIV clinics in south London had diabetes or pre-diabetes, while a Liverpool HIV clinic found that 70% of patients with diabetes were not able to achieve targets for blood sugar control, presentations at the International Congress on Drug Therapy in HIV Infection (HIV Glasgow) earlier this month showed.
The findings highlight the need for greater awareness of the risk of type 2 diabetes and poorly-controlled blood sugar among people living with HIV, say investigators.
Type 2 diabetes is one of the most common chronic health conditions in older adults. Diabetes UK estimates that approximately 6% of people in the United Kingdom are living with diagnosed or undiagnosed diabetes. The long-term consequences of poorly-controlled blood sugar include increased risks of heart disease, kidney disease and sight loss. The risk of developing type 2 diabetes increases with age and is higher in people of South Asian, Black African and Black Caribbean ancestry. Obesity greatly increases the risk of developing type 2 diabetes.
Doctors at King’s College Hospital and Guy’s and St Thomas’s Hospital reviewed the prevalence of elevated glucose levels and type 2 diabetes in 338 patients with HIV receiving care at their clinics. The sample was constructed to reflect the demographics of patients receiving care at the clinics; 49% were Caucasian, 31% Black African and 17% Black Caribbean. The median age was 49 years and 74% were male.
The prevalence of type 2 diabetes was high: 15% had diabetes (fasting glucose >7.0 mmol/l) and 17% had pre-diabetes (6.0-6.9 mmol/l). The prevalence of type 2 diabetes and pre-diabetes increased substantially in people aged 40 and over. Whereas 14% of those aged 40-49 had diabetes and 17% had pre-diabetes, in both the age groups 60-69 and 70-79, the prevalence of diabetes increased to 33% and of pre-diabetes to 25%.
To assess whether QRISK2 scores for 10-year cardiovascular risk could predict the presence of pre-diabetes, the researchers plotted pre-diabetes diagnoses against QRISK2 scores and found that a score of 4 or above predicted an increased diabetes risk with a sensitivity of 72% and a specificity of 51%.
The study investigators concluded that in the absence of an up-to-date HbA1c measurement, anyone aged 40 or over with a cardiovascular risk score of 4 or above on the QRISK2 tool should be investigated for pre-diabetes or diabetes.