Prevalence and Risk Factors for Diabetes Mellitus among newly-diagnosed HIV-infected South African Adults

Abstract Prevalence and Risk Factors for Diabetes Mellitus among newly-diagnosed HIV-infected South African Adults Joseph Murphy Chair of the Supervisory Committee: Paul Drain, MD Department of Epidemiology Background: Non-communicable diseases and their risk factors, including diabetes mellitus, have been increasing in HIV-endemic resource-limited settings. We sought to determine the prevalence and risk factors for diabetes in HIV-infected South African adults. Methods: We conducted a cross-sectional study of newly diagnosed HIV-infected adults in a poor urban township in KwaZulu-Natal, South Africa. We used indicators for demographic, socioeconomic, and substance use prior to HIV testing. We defined diabetes as having a hemoglobin A1c (HbA1c) ≥6.5% or in the absence of this test, a random blood glucose (RBG) ≥11.1 mmol/L, and prediabetes was defined as HbA1c 5.7-6.4% or RBG 7.8-11.1 mmol/L. We used logistic regression to identify risk factors for prediabetes or diabetes. Results: Among 1,048 HIV-infected adults, mean age was 33 years, 630 (60.1%) were female, and 253 (24.2%) were obese. The prevalence of diabetes and prediabetes were 2.8% and 7.4%, respectively. In the multivariate model, age 45 years or older (8.50 OR, 95% CI: 3.27-22.07), BMI greater than 30 kg/m2 (23.60 OR, 95% CI: 11.41-48.85), female sex (2.20 OR, 95% CI: 1.39-3.48), greater than 5 kilometers from a clinic (1.98 OR, 95% CI: 1.11-3.55), hypertension (2.64 OR, 95% CI:1.55-4.49), CD4 cell counts >350 (1.97 OR, 95% CI:1.06-3.67) and cigarettes use (0.34 OR, 95% CI: 0.15-0.76) were associated with a higher odds of diabetes or prediabetes. None of the 1,048 participants who had either pre-diabetes or diabetes were aware of their diagnosis or reported receiving diabetic treatment. Conclusions: The prevalence of prediabetes or diabetes was over 10% among newly diagnosed HIV-infected adults in South Africa, and none of these adults were aware of their condition or receiving therapy. Screening may target those who are obese, live farther away from a clinic, older age, have hypertension, have higher CD4 counts and females, while treatment for diabetes needs to be expanded among all HIV-infected adults.