Factors Associated with Achieving Glycemic Control and the Role of Glycated Hemoglobin Levels on Diabetes-Related Outcomes and Immune Recovery Among Diabetic Patients in a Citywide Cohort of HIV-Infected Persons in Care
Open AccessThe availability of antiretroviral therapy has resulted in persons with HIV (PWH) living longer. Clinical care for PWH now involves treatment for noncommunicable diseases, including type 2 diabetes mellitus (DM). Discovering the optimal management of DM and ways to achieve it are necessary to improve care for PWH with DM. Data from the DC Cohort, a prospective cohort of PWH receiving HIV care in Washington, DC, were utilized to conduct three analyses related to glycemic control in PWH with DM. The first analysis assessed the individual-and clinic-level factors associated with achieving a hemoglobin A1c (HbA1c) ≤7.0% using multilevel marginal extended Cox regression. Both individual- and clinical factors were associated with achieving a HbA1c ≤7.0%. The second analysis examined HbA1c trends over time and assessed the association with the diabetes-related outcome development. Latent class growth modeling identified three distinct HbA1c trajectory subgroups, strict glycemic control, moderate glycemic control, and inadequate glycemic control. Multivariable logistic regression was used to determine that those with inadequate glycemic control had a greater risk of developing a diabetes-related outcome. However, there were no differences between those with moderate glycemic control compared to those with strict glycemic control. The third analysis explored the impact of glycemic control on trends in CD4 count using linear mixed-effects regression. All HbA1c groups had a similar increase over time in CD4 count. Participants with moderate HbA1c levels had a slightly higher adjusted mean difference in CD4 counts than strict HbA1c control.The results and findings from this research could have a significant public health impact for PWH with DM. Results of the first analysis provide clinicians insight on the services and actions that can be implemented at the clinic level to help patients achieve glycemic control goals, and provide support for these specific programs and services to be the standard of care for clinics and providers treating PWH with DM. Future research that looks at service utilization could aid in determining the strength of the association between available services and achievement of glycemic control. The findings from the second and third analyses showed that moderate glycemic control did not result in an increase in the development of diabetes-related outcomes nor negatively impact immune function for PWH with DM. These analyses offer evidence that the target HbA1c recommended for PWH with DM could be higher than 7%, however, further research should be done to replicate these results. Additionally, other research examining if additional health benefits (such as a decrease in hypoglycemic outcomes or improved medication adherence) are associated with a more lenient HbA1c target are recommended. Overall, the knowledge gained from determining factors associated with achieving a HbA1c target, as well as what level of glycemic control is necessary to prevent the development of poor outcomes, may lead to enhanced quality of care, updated management guidelines, and ultimately improved quality of life for PWH with DM.
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PowersHapp_gwu_0075A_15324.pdf | 2021-01-10 | Open Access |
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