Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: A potential new entity of diabetes in HIV?

Daniel Faurholt-Jepsen; Mette Frahm Olsen; Anna Birkmose Andersen; Pernille Kæstel; Alemseged Abdissa; Hiwot Amare; Daniel Yilma; Tsinuel Girma; Markos Tesfaye; Åse Bengård Andersen; Henrik Friis; Marit Eika Jørgensen

doi:10.1097/QAD.0000000000002249

Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: A potential new entity of diabetes in HIV?

Daniel Faurholt-Jepsen^*, Mette Frahm Olsen, Anna Birkmose Andersen, Pernille Kæstel, Alemseged Abdissa, Hiwot Amare, Daniel Yilma, Tsinuel Girma, Markos Tesfaye, Åse Bengård Andersen, Henrik Friis, Marit Eika Jørgensen

^*Corresponding author af dette arbejde

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Abstract

Background:Although diabetes is more common in HIV patients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIV patients.Methods:Among HIV patients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and 1-acid glycoprotein were used as same-day markers of inflammation.Results:Among 332 HIV patients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and 1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference.Conclusion:ART-naive Ethiopian HIV patients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIV patients.

Originalsprog	Engelsk
Tidsskrift	AIDS (Year)
Vol/bind	33
Udgave nummer	10
Sider (fra-til)	1595-1602
Antal sider	8
ISSN	1350-2840
DOI	https://doi.org/10.1097/QAD.0000000000002249
Status	Udgivet - 1 aug. 2019

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10.1097/QAD.0000000000002249

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Faurholt-Jepsen, D., Olsen, M. F., Andersen, A. B., Kæstel, P., Abdissa, A., Amare, H., Yilma, D., Girma, T., Tesfaye, M., Andersen, Å. B., Friis, H., & Jørgensen, M. E. (2019). Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: A potential new entity of diabetes in HIV? AIDS (Year), 33(10), 1595-1602. https://doi.org/10.1097/QAD.0000000000002249

Faurholt-Jepsen, D, Olsen, MF, Andersen, AB, Kæstel, P, Abdissa, A, Amare, H, Yilma, D, Girma, T, Tesfaye, M, Andersen, ÅB, Friis, H & Jørgensen, ME 2019, 'Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: A potential new entity of diabetes in HIV?', AIDS (Year), bind 33, nr. 10, s. 1595-1602. https://doi.org/10.1097/QAD.0000000000002249

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title = "Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: A potential new entity of diabetes in HIV?",

abstract = "Background:Although diabetes is more common in HIV patients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIV patients.Methods:Among HIV patients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and 1-acid glycoprotein were used as same-day markers of inflammation.Results:Among 332 HIV patients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and 1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference.Conclusion:ART-naive Ethiopian HIV patients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIV patients.",

keywords = "Faculty of Science, Diabetes, Glycosylated hemoglobin, HIV, Insulin deficiency, Insulin resistance, Opportunistic infection",

author = "Daniel Faurholt-Jepsen and Olsen, {Mette Frahm} and Andersen, {Anna Birkmose} and Pernille K{\ae}stel and Alemseged Abdissa and Hiwot Amare and Daniel Yilma and Tsinuel Girma and Markos Tesfaye and Andersen, {{\AA}se Beng{\aa}rd} and Henrik Friis and J{\o}rgensen, {Marit Eika}",

note = "CURIS 2019 NEXS 227",

year = "2019",

month = aug,

day = "1",

doi = "10.1097/QAD.0000000000002249",

language = "English",

volume = "33",

pages = "1595--1602",

journal = "AIDS, Supplement",

issn = "1350-2840",

publisher = "Lippincott Williams & Wilkins, Ltd.",

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TY - JOUR

T1 - Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia

T2 - A potential new entity of diabetes in HIV?

AU - Faurholt-Jepsen, Daniel

AU - Olsen, Mette Frahm

AU - Andersen, Anna Birkmose

AU - Kæstel, Pernille

AU - Abdissa, Alemseged

AU - Amare, Hiwot

AU - Yilma, Daniel

AU - Girma, Tsinuel

AU - Tesfaye, Markos

AU - Andersen, Åse Bengård

AU - Friis, Henrik

AU - Jørgensen, Marit Eika

N1 - CURIS 2019 NEXS 227

PY - 2019/8/1

Y1 - 2019/8/1

N2 - Background:Although diabetes is more common in HIV patients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIV patients.Methods:Among HIV patients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and 1-acid glycoprotein were used as same-day markers of inflammation.Results:Among 332 HIV patients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and 1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference.Conclusion:ART-naive Ethiopian HIV patients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIV patients.

AB - Background:Although diabetes is more common in HIV patients, the direct link between HIV and diabetes is unknown. Glucose abnormalities should be assessed among antiretroviral treatment (ART)-naive patients to reduce confounding by ART. We assessed diabetes status, insulin function and association with inflammation among Ethiopian ART-naive HIV patients.Methods:Among HIV patients initiating ART, we used glycosylated hemoglobin (HbA1c) and oral glucose tolerance test (OGTT) to define prediabetes and diabetes. Insulin during OGTT was determined to calculate insulin function, and C-reactive protein and 1-acid glycoprotein were used as same-day markers of inflammation.Results:Among 332 HIV patients, mean (SD) age was 32.9 (8.8) years, and 222 (66.9%) were women. None had known diabetes, but we found diabetes prevalence using OGTT and HbA1c to be 7.6 and 8.5%, respectively. C-reactive protein and 1-acid glycoprotein were positively associated with hyperglycemia and insulin deficiency, but not insulin resistance. We found poor correlation between traditional risk factors (age and anthropometry) and diabetes, but participants generally had low BMI and waist circumference.Conclusion:ART-naive Ethiopian HIV patients had a high prevalence of prediabetes and diabetes, with a poor agreement between HbA1c and OGTT. Diabetes was associated with inflammation, but not with adiposity and age. Diabetes was linked to insulin deficiency, rather than insulin resistance, which may represent a different entity than type 1 and 2 diabetes. This has implications for choice of drugs, when managing diabetes in African HIV patients.

KW - Faculty of Science

KW - Diabetes

KW - Glycosylated hemoglobin

KW - HIV

KW - Insulin deficiency

KW - Insulin resistance

KW - Opportunistic infection

U2 - 10.1097/QAD.0000000000002249

DO - 10.1097/QAD.0000000000002249

M3 - Journal article

C2 - 31306166

SN - 1350-2840

VL - 33

SP - 1595

EP - 1602

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 10

ER -

Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia: A potential new entity of diabetes in HIV?

Abstract

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