Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis?
Abstract Background Antiretroviral therapy dramatically reduced HIV-related morbidity and mortality, prolonging the lifespan of HIV-infected patients. Greater duration of infection and exposure to antiretroviral therapy makes these patients susceptible to traditional cardio-metabolic risk factors an...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-07-01
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| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-018-3221-7 |
| _version_ | 1819016574047092736 |
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| author | Ana Rita Coelho Flávia Andreia Moreira Ana Cristina Santos André Silva-Pinto António Sarmento Davide Carvalho Paula Freitas |
| author_facet | Ana Rita Coelho Flávia Andreia Moreira Ana Cristina Santos André Silva-Pinto António Sarmento Davide Carvalho Paula Freitas |
| author_sort | Ana Rita Coelho |
| collection | DOAJ |
| description | Abstract Background Antiretroviral therapy dramatically reduced HIV-related morbidity and mortality, prolonging the lifespan of HIV-infected patients. Greater duration of infection and exposure to antiretroviral therapy makes these patients susceptible to traditional cardio-metabolic risk factors and pathologies. The optimal diagnostic protocol for Diabetes Mellitus in these patients is still controversial. Haemoglobin A1c (HbA1c) has been shown to underestimate glycaemia levels and the oral glucose tolerance test (OGTT) has been shown to reveal cases of glucose metabolism disturbances in patients with normal fasting glucose. Thus, this study aimed to determine the prevalence of prediabetes and diabetes in a population of HIV-infected patients undergoing combined antiretroviral therapy, using three different diagnostic methods (fasting glucose, OGTT and HbA1c), to determine the agreement between the different methods and the characteristics associated with each one. Methods This study analyzed 220 HIV-infected patients on antiretroviral therapy. Patient characteristics were collected using a standardized protocol. Disturbances of glucose homeostasis were defined by the ADA 2017 criteria. Patients were characterized according to the presence or absence of clinical lipodystrophy, and distributed into four different categories, according to the presence, or absence of either clinical lipoatrophy, or abdominal prominence. Insulin resistance was assessed by HOMA-IR and QUICKI indexes. Agreement between the diagnostic methods was assessed by Cohen’s kappa coefficient. Results There were no patients diagnosed with diabetes with HbA1c. 5.9% prevalence was obtained when OGTT was used, and 3.2% prevalence when fasting glucose was used. Prediabetes had a prevalence of 14.1% when using HbA1c, 24.1% when using OGTT, and 20% when using fasting glucose. In all three methods, glucose homeostasis disturbances were associated with older age and higher resistance to insulin. Regarding other characteristics, associations varied between the three methods. The agreement between them was fair, or slight. Conclusions We observed that HbA1c was the method that diagnosed the least amount of cases and that OGTT was the one that diagnosed the most cases. Accordingly, our results indicate that HbA1c underestimated glycaemia levels in this population and that the use of OGTT might allow an earlier diagnosis of glucose homeostasis disturbances, potentially making it possible to avoid severe complications of DM. |
| first_indexed | 2024-12-21T02:49:47Z |
| format | Article |
| id | doaj.art-0213cd37d1b54bde9ee3209711b523d0 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-21T02:49:47Z |
| publishDate | 2018-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-0213cd37d1b54bde9ee3209711b523d02022-12-21T19:18:28ZengBMCBMC Infectious Diseases1471-23342018-07-0118111310.1186/s12879-018-3221-7Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis?Ana Rita Coelho0Flávia Andreia Moreira1Ana Cristina Santos2André Silva-Pinto3António Sarmento4Davide Carvalho5Paula Freitas6Medical Student. Faculty of Medicine, University of Porto. Alameda Prof. Hernâni MonteiroMedical Student. Faculty of Medicine, University of Porto. Alameda Prof. Hernâni MonteiroEPIUnit - Instituto de Saúde Pública, Universidade do PortoInfectious Diseases Department, Centro Hospitalar São JoãoInfectious Diseases Department, Centro Hospitalar São JoãoEndocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, and Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of PortoEndocrinology, Diabetes and Metabolism Department, Centro Hospitalar São João, and Faculty of Medicine, i3S - Instituto de Investigação e Inovação em Saúde, University of PortoAbstract Background Antiretroviral therapy dramatically reduced HIV-related morbidity and mortality, prolonging the lifespan of HIV-infected patients. Greater duration of infection and exposure to antiretroviral therapy makes these patients susceptible to traditional cardio-metabolic risk factors and pathologies. The optimal diagnostic protocol for Diabetes Mellitus in these patients is still controversial. Haemoglobin A1c (HbA1c) has been shown to underestimate glycaemia levels and the oral glucose tolerance test (OGTT) has been shown to reveal cases of glucose metabolism disturbances in patients with normal fasting glucose. Thus, this study aimed to determine the prevalence of prediabetes and diabetes in a population of HIV-infected patients undergoing combined antiretroviral therapy, using three different diagnostic methods (fasting glucose, OGTT and HbA1c), to determine the agreement between the different methods and the characteristics associated with each one. Methods This study analyzed 220 HIV-infected patients on antiretroviral therapy. Patient characteristics were collected using a standardized protocol. Disturbances of glucose homeostasis were defined by the ADA 2017 criteria. Patients were characterized according to the presence or absence of clinical lipodystrophy, and distributed into four different categories, according to the presence, or absence of either clinical lipoatrophy, or abdominal prominence. Insulin resistance was assessed by HOMA-IR and QUICKI indexes. Agreement between the diagnostic methods was assessed by Cohen’s kappa coefficient. Results There were no patients diagnosed with diabetes with HbA1c. 5.9% prevalence was obtained when OGTT was used, and 3.2% prevalence when fasting glucose was used. Prediabetes had a prevalence of 14.1% when using HbA1c, 24.1% when using OGTT, and 20% when using fasting glucose. In all three methods, glucose homeostasis disturbances were associated with older age and higher resistance to insulin. Regarding other characteristics, associations varied between the three methods. The agreement between them was fair, or slight. Conclusions We observed that HbA1c was the method that diagnosed the least amount of cases and that OGTT was the one that diagnosed the most cases. Accordingly, our results indicate that HbA1c underestimated glycaemia levels in this population and that the use of OGTT might allow an earlier diagnosis of glucose homeostasis disturbances, potentially making it possible to avoid severe complications of DM.http://link.springer.com/article/10.1186/s12879-018-3221-7HIV infectionDiabetes mellitus diagnosisFasting glucoseOral glucose tolerance testHbA1c |
| spellingShingle | Ana Rita Coelho Flávia Andreia Moreira Ana Cristina Santos André Silva-Pinto António Sarmento Davide Carvalho Paula Freitas Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis? BMC Infectious Diseases HIV infection Diabetes mellitus diagnosis Fasting glucose Oral glucose tolerance test HbA1c |
| title | Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis? |
| title_full | Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis? |
| title_fullStr | Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis? |
| title_full_unstemmed | Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis? |
| title_short | Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis? |
| title_sort | diabetes mellitus in hiv infected patients fasting glucose a1c or oral glucose tolerance test which method to choose for the diagnosis |
| topic | HIV infection Diabetes mellitus diagnosis Fasting glucose Oral glucose tolerance test HbA1c |
| url | http://link.springer.com/article/10.1186/s12879-018-3221-7 |
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