Glycemic Response Independent of Initial Diabetic Medication in HIV-Infected Patients With T2D

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No significant difference in HbA1c was found among patients taking metformin, sulfonylurea, or thiazolidinedione at 1 year.
No significant difference in HbA1c was found among patients taking metformin, sulfonylurea, or thiazolidinedione at 1 year.

Glycemic response was not affected by specific diabetic oral medication type given to patients with type 2 diabetes infected with HIV, according to recent research published in Diabetes Care.

"In this longitudinal cohort of HIV-infected and uninfected new users of oral diabetic medical therapy, we found that glycemic response was independent of the initial class of medication after controlling for potential confounders," Jennifer H. Han, MD, MSCE, assistant professor at the Perelman School of Medicine, University of Pennsylvania, and colleagues wrote in their study. "HIV infection similarly did not impact the initial glycemic response."

 

Dr Han and colleagues measured the changes in glycated hemoglobin (HbA1c) level among patients in the Veterans Aging Cohort Study Virtual Cohort (VACS-VC) with type 2 diabetes with and without HIV infection taking oral diabetic medications between 1999 and 2010, according to the abstract.

There were a total of 2454 patients infected with HIV and 892 patients not infected with HIV included in the study. Patients began taking metformin (n = 5647), a sulfonylurea (n = 5554), or a thiazolidinedione (n = 145) at the index date, and researchers reviewed the absolute change in HbA1c at 1-year follow-up. The mean age in the study was 53 years; the cohort was 98% men, 47% black (n = 5387), 40% white (n = 4551), and 10% Hispanic (n = 1156).

The researchers found no significant difference in HbA1c in any of the patients taking metformin (mean absolute change, –0.95%; 95% CI, –1.05% to –0.85% [–10.5 mmol/mol; 95% CI, –11.5 to –9.3 mmol/mol]), sulfonylurea (mean absolute change, –1.43%; 95% CI, –1.58% to –1.29% [–15.6 mmol/mol; 95% CI, –17.3 to –14.1 mmol/mol]), or thiazolidinedione (mean absolute change, –0.12%; 95% CI, –0.62% to 0.38% [–1.3 mmol/mol; 95% CI, –6.8 to 4.2 mmol/mol]) at 1-year follow-up, and there was no significant change in HbA1c regarding HIV infection status (P =.24).

Compared with white patients, Dr Han and colleagues also found that black patients had an increase in HbA1c of 0.16% (95% CI, 0.08%-0.24% [1.7 mmol/mol; 95% CI, 0.9-2.6]; P <.001), and Hispanic patients had an increase in HbA1c of 0.25% (95% CI, 0.11%-0.39% [2.7 mmol/mol; 95% CI, 1.2-4.3 mmol/mol]; P = .001).

The investigators noted that more research was needed to explain why patients with factors such as black race and Hispanic ethnicity had a poorer response to diabetic medical therapy.

"Ultimately, given the increasing prevalence of type 2 diabetes in the aging HIV-infected population, further research is needed to elucidate the safety of diabetic medications in HIV-infected patients with type 2 diabetes, as well as the effects on long-term clinical complications and mortality," Dr Han and colleagues wrote.

Reference

  1. Han J, Gordon K, Womack J, et al. Comparative effectiveness of diabetic oral medications among HIV-infected and HIV-uninfected veterans [published online September 15, 2016]. Diabetes Care. doi: 10.2337/dc16-0718
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