1285-P: Disparities in Screening, Diagnosis, and Treatment of Type 2 Diabetes Mellitus among Persons with HIV

Abstract

Background: Persons with HIV (PWH) have normal life expectancy on antiretroviral therapy (ART), but a rising burden of type 2 diabetes mellitus (DM) disproportionately affecting women and Black individuals threatens these gains. We therefore assessed whether disparities in DM incidence are reflected in disease screening and treatment by HIV providers. Methods: PWH on ART with ≥2 clinic visits at a large HIV clinic in the southeast from 2007-2022 contributed data, if they did not have prevalent DM at enrollment: existing ICD-9/10 diagnoses of DM, antidiabetic medication, hemoglobin A1c (A1c) ≥6.5%, or random glucose ≥200 mg/dL. We assessed the association of demographic and clinical factors with DM screening by A1c and, among those with incident DM by A1c or ICD-9/10 diagnosis or random glucose, DM treatment and achievement of goal (i.e., A1c ≤7.0%). For each “care continuum” step, we used modified Poisson regression to estimate adjusted incidence rate ratios (IRRs) of reaching the next step by these factors. Results: Among 5450 PWH enrolling, 3762 (69%) were screened for DM by A1c, of whom 1001 (27%) had dysglycemia (A1c >5.7%) and 162 (4.3%) were diagnosed with DM. Among 186 PWH with incident DM, 136 (73%) initiated antidiabetic medication and 94 (84%) achieved an A1c ≤7.0%. Older, Black, and overweight or obese PWH were more likely to be screened (IRRs=1.0-1.1, p<0.05 each) and diagnosed with DM (IRRs=1.8-2.8, p<0.05 each), but there was no significant sex difference in the adjusted model. Of those screened and diagnosed with DM, no clinical or demographic factors were associated with DM treatment initiation or achieving A1c goal. Conclusions: Older, Black, and overweight/obese PWH were more likely to be screened for and diagnosed with DM. However, we found no disparities in initiating DM medications or achieving an A1c goal. While DM screening among PWH warrants improvement, women and Black PWH, two groups with a higher risk of DM, did not appear to be treated disparately in this population. Disclosure N.Millman: None. J.Koethe: Advisory Panel; Merck Sharp & Dohme Corp., Janssen Pharmaceuticals, Inc., Gilead Sciences, Inc., Theratechnologies, Research Support; Merck Sharp & Dohme Corp. M.Turner: None. K.Bourgi: Advisory Panel; Gilead Sciences, Inc., Theratechnologies, Research Support; Gilead Sciences, Inc. T.Sterling: None. P.Rebeiro: Consultant; Gilead Sciences, Inc., Janssen Pharmaceuticals, Inc., Research Support; National Institutes of Health. Funding National Institutes of Health (P30AI110527)