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Veterans with HIV Responsive to Standard Diabetes Therapy

By U.S. Medicine

PHILADELPHIA—With Type 2 diabetes  increasingly common in HIV-infected individuals, are standard oral diabetes medications as effective in that population?

That was the concern explored in a study published in the journal Diabetes Care. University of Pennsylvania researchers and colleagues compared glycemic effectiveness of oral diabetic medications among patients with and without HIV infection.1

The VA Greater Los Angeles Health Care System, the Atlanta VAMC and the  Michael E. DeBakey VAMC in Houston participated in the longitudinal cohort study of HIV-infected and uninfected veterans with Type 2 diabetes initiating diabetic medications between 1999 and 2010.

Generalized estimating equations were used to compare changes in hemoglobin A1c (HbA1c) through the year after medication initiation, adjusting for baseline HbA1c level and clinical covariates the 2,454 HIV-infected patients and 8,892 HIV-uninfected patients initiating diabetic medications during the study period.

Half the patients were prescribed metformin, while nearly half received a sulfonylurea  and the remaining were prescribed a thiazolidinedione.

Results indicate that, after adjustment for potential confounders, no significant difference was detected in the change in HbA1c level among the three groups of new users. Furthermore, HIV infection was not significantly associated with glycemic response.

The study found that black and Hispanic patients had a poorer response to therapy compared with white patients, with a relative increase in HbA1clevel of 0.16% and 0.25%, respectively.

“We found that glycemic response was independent of the initial class of diabetic medication prescribed among HIV-uninfected and HIV-infected adults with Type 2 diabetes,” study authors conclude. “The mechanisms leading to poorer response among black and Hispanic patients, who comprise a substantial proportion of those with HIV infection and Type 2 diabetes, require further investigation.”

  1. Han JH, Gordon K, Womack JA, Gibert CL, Leaf DA, Rimland D, Rodriguez-Barradas MC, Bisson GP. Comparative Effectiveness of Diabetic Oral Medications Among HIV-Infected and HIV-Uninfected Veterans. Diabetes Care. 2016 Sep 15. pii: dc160718. [Epub ahead of print] PubMed PMID: 27634393.

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