The Prevalence and Outcome of pre-DM/DM in an Urban HIV Primary Care Clinic

Abstract

Background Diabetes mellitus (DM) is an important cause of mortality and morbidity in the US. There are limited data on DM prevalence among HIV infected patients (HIV+ patients). A recent study found that DM prevalence was higher among HIV+ patients (10.3%) vs. the general US population (8.3%), and was higher regardless of age, sex, and obesity status. We report on the prevalence of pre-DM/DM in our HIV clinic and outcomes.Methods Cross-sectional study by retrospective medical record review of patients ≥ 18 years who received HIV primary care at the Peter Krueger Clinic (PKC) at Mount Sinai Beth Israel, NY during October 2015–September 2016. The endocrine clinic is located outside PKC. Data collected include prevalence of pre-DM (Hgb A1C 5.7–6.4) and DM, demographics and HIV disease characteristics. Inadequate glycemic control was defined as Hgb A1C ≥ 7.0 in ≥ 50% of measures during study.ResultsThere were 1137 HIV+ patients during the study period. The population was mostly Black or Hispanic; mean age was 52.6 ± 11.2 years; 70% were male. Pre-DM prevalence was 301/1137 (26.5%) and DM prevalence was 176/1137 (15.5%). In univariate analysis, patients with DM were more likely to be older, female, Hispanic, HCV co-infected, had higher BMI, longer duration of HIV infection, and family history of DM (all p values < 0.05). Almost 40% of those with DM were also HCV co-infected. Of the 176 with DM, 91 (52%) had inadequate glycemic control. Only insulin use and referral to endocrinology were associated with poor control (P <0.05).Conclusion Rates of DM in our HIV clinic were almost twice the rate reported in the adult US population (8.3%) and 25% had pre DM. Traditional risk factors such as older age, family history, and higher BMI were more frequent in our population. The poorer outcomes in those referred to endocrine probably reflect difficult to manage advanced DM that prompted endocrine referral. The high rates of DM and pre DM supports the DHHS recommendation for screening and consideration of co-location of endocrine services to promote appropriate glycemic controlDisclosures All authors: No reported disclosures.