Abstract
BackgroundThe burden of diabetes is increasing in sub-Saharan Africa, including among people living with HIV. We assessed the prevalence of diabetes and the roles of HIV, antiretroviral therapy (ART) and traditional risk factors among adults in Tanzania.MethodsWe analysed diabetes-relevant baseline data from 1,947 adult participants in the CICADA study in Mwanza, Tanzania: 655 HIV-uninfected, 956 HIV-infected ART-naïve, and 336 HIV-infected persons on ART. WHO guidelines for haemoglobin A1c (HbA1c) and oral glucose tolerance test (OGTT) were used to define diabetes and prediabetes. Risk factors were evaluated using multinomial logistic regression analysis. Relative risk ratios (RRR) were generated comparing participants with diabetes and prediabetes against the reference of those with no diabetes.ResultsMean age was 41 (SD 12) years; 59% were women. The prevalence of diabetes was 13% by HbA1c and 6% by OGTT, with partial overlap among participants identified by the two tests. Relative to HIV-uninfected, HIV-infected ART-naïve persons had increased relative risks of diabetes (HbA1c: RRR = 1.95, 95% CI 1.25–3.03; OGTT: RRR = 1.90, 95% CI 0.96–3.73) and prediabetes (HbA1c: RRR = 2.89, 95% CI 1.93–4.34; OGTT: RRR = 1.61, 95% CI 1.22–2.13). HIV-infected participants on ART showed increased risk of prediabetes (RRR 1.80, 95% CI 1.09, 2.94) by HbA1c, but not diabetes. CD4 count < 200 cell/μL at recruitment increased risk and physical activity decreased risk of diabetes by both HbA1c and OGTT.ConclusionsThe prevalence of diabetes was high, especially among HIV-infected ART-naïve adults. Being more physically active was associated with lower risk of diabetes. HbA1c and OGTT identified different participants as having diabetes or prediabetes. Overall, the finding of high burden of diabetes among HIV-infected persons suggests that health systems should consider integrating diabetes screening and treatment in HIV clinics to optimize the care of HIV patients and improve their health outcomes.
Highlights
Diabetes mellitus is an emerging public health problem in sub-Saharan Africa (SSA) [1, 2], due to the nutrition transition and globalization [1, 3]
The prevalence of diabetes was 13% by haemoglobin A1c (HbA1c) and 6% by oral glucose tolerance test (OGTT), with partial overlap among participants identified by the two tests
Relative to HIV-uninfected, HIV-infected antiretroviral therapy (ART)-naïve persons had increased relative risks of diabetes (HbA1c: Relative risk ratios (RRR) = 1.95, 95% CI 1.25–3.03; OGTT: RRR = 1.90, 95% CI 0.96–3.73) and prediabetes (HbA1c: RRR = 2.89, 95% CI 1.93–4.34; OGTT: RRR = 1.61, 95% CI 1.22–2.13)
Summary
Diabetes mellitus is an emerging public health problem in sub-Saharan Africa (SSA) [1, 2], due to the nutrition transition and globalization [1, 3]. Compared to people from high-income countries, inhabitants of SSA seem to be at risk of diabetes at younger age and may have different risk factors including HIV infection [3, 5, 6]. HIV and ART may have similar effects on diabetes in SSA as in high-income countries, such data cannot be directly extrapolated to SSA because of differing risk factors such as a lower prevalence of obesity, history of nutritional deficiencies, higher exposure to infections, and use of older antiretroviral drugs which have been associated with excess diabetes risk [14,15,16,17]. We assessed the prevalence of diabetes and the roles of HIV, antiretroviral therapy (ART) and traditional risk factors among adults in Tanzania
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