ObjectiveWe sought to determine the incidence and factors associated with development of diabetes mellitus (DM) in older HIV-infected individuals.Research design and methodsWe analyzed data from people living with HIV (PLWH) ≥50 years of age enrolled in a large urban HIV outpatient clinic in Vancouver, British Columbia. Patients were categorized as having DM if they had random blood sugar ≥11.1 mmol/L, fasting blood sugar ≥7 mmol/L, HbA1C ≥6.5%, antidiabetic medication use during the follow-up period, or medical chart review confirming diagnosis of DM. We estimated the probability of developing DM, adjusting for demographic and clinical factors, using a logistic regression model.ResultsAmong 1065 PLWH followed for a median of 13 years (25th and 75th percentile (Q1–Q3): 9-18), the incidence of DM was 1.61/100 person-years follow-up. In the analysis of factors associated with new-onset DM (n=703), 88% were male, 38% had a history of injection drug use, 43% were hepatitis C coinfected, and median body mass index was 24 kg/m2 (Q1–Q3: 21–27). Median age at antiretroviral therapy (ART) initiation was 48 years (Q1–Q3: 43–53) and at DM diagnosis was 55 years (Q1–Q3: 50–61). Patients who started ART in 1997–1999 and had a longer exposure to older ART were at the highest risk of developing DM.ConclusionsAmong PLWH aged ≥50 years, the incidence of DM was 1.39 times higher than men in the general Canadian population of similar age. ART initiated in the early years of the epidemic and exposure to older ART appeared to be the main drivers of the development of DM.

No abstract

I n Canada, health inequities have been well documented in rural, remote and northern areas. As a result, improving rural health is often a priority area for health research and service delivery. For example, rural, remote and northern areas in Canada have been found to have higher rates of all-cause mortality, chronic kidney disease, obesity, cerebrovascular disease and maternal morbidity. 1-4 In addition to higher incidence and prevalence of chronic diseases, disease-specific outcomes and use of evidence-based therapies are poorer in rural areas. 5-7 Infection with HIV is a chronic disease with many reported geographic discrepancies in care in high-income countries. With appropriate care and medications, the life expectancy of those living with HIV can approach that of the general population. 8 Despite advances in HIV care, people in rural areas experience more advanced disease at diagnosis, delayed linkage to care, more rapid disease progression and increased mortality. 9-14 The relation between rurality and health outcomes is complex and is driven by intersecting determinants, including poverty, education, industries that extract natural resources, colonialism, health human resources and travel distances. 15-21 Further complicating health analyses on rurality are heterogeneity among rural areas, varying definitions of rurality and authors' failure to justify selected definitions. 22,23 In Canada, common definitions rely on population census categorizations, postal codes or rurality indices. 24-26