Diabetes in HIV-positive patients on the rise

HIV-positive diabetics are not achieving optimal control of their blood glucose - a condition that exposes these vulnerable patients to even greater risk of major diseases such as neuropathy (kidney damage) and tuberculosis - a study has found.

Cape Argus, 27 April 2016

The study, which was conducted by the University of KwaZulu-Natal on more than 600 diabetic patients attending a Pietermaritzburg clinic between 2012 and 2013, compared differences in glycaemic control or blood sugar, blood pressure and cholesterol levels between HIV-positive and HIV-negative diabetic patients. In South Africa, a country grappling with effects of HIV/AIDS, diabetes, a complication of HIV, is on the rise. Both ARVS and the severity of HIV infection predispose patients to the development of diabetes.

HIV-positive patients are twice as likely to develop type 2 diabetes compared with HIV-negative individuals. According to the latest study, researchers also found that HIV-negative patients were less likely to be obese than their HIV-positive counterparts while both groups were deficient in Vitamin B12 - a condition that could result in anaemia. Researchers conducting the study also found that a significant proportion of all diabetic patients (both HIV-infected and uninfected) in the study had high cholesterol.

The majority of the HIV-infected diabetic patients - or 85.23 percent - displayed suboptimal glycaemic control, with those on antiretrovirals showing even poorer control at 89 percent. Only one in seven diabetic HIV-positive patients achieved target in glycated haemoglobin (HbA1c), which identifies average plasma glucose concentration.

The study also showed that HIV-positive diabetic patients showed a higher prevalence of nephropathy, while their counterparts were found to have a significantly higher chronic renal disease and renal failure. The HIV-infected cohort demonstrated a high incidence of obesity at almost 56 percent - prompting researchers to call for modification of lifestyle, irrespective of whether a patient is HIV-infected or not. Increased body mass index, waist circumferences and low CD4 counts were associated with increased risk of development of diabetes in HIV-positive patients. Although no significant differences were noted between HIV-positive and HIV-negative diabetic patients with regard to optimal BP achieved, a significant proportion (57.89 percent) of the HIV-infected patients failed to achieve optimal BP control.

Writing in the SA Medial Journal, lead researcher Somasundram Pillay said the latest study provided a baseline and illustrated that the healthcare sector achieved suboptimal glycaemic and blood pressure control in diabetic patients, both HIV-infected and uninfected.

Pillay said this spells disaster, as the combination of HIV and poor glycaemic control will increase the risk of these patients developing TB and will further worsen the current burden of communicable diseases on developing countries like SA.