Diagnosing Diabetes Mellitus With Glycated Haemoglobin in Newly Diagnosed HIV-positive Patients in Buffalo City Municipality, South Africa: A Cross-sectional Study

Abstract

Background: The HbA1c estimates long-term glycaemic control in individuals. However, scanty data exist on the determination of Diabetes Mellitus (DM) in newly diagnosed HIV patients using the HbA1c screening tool in the South African context. Thus, this study examines the prevalence of diabetes mellitus in newly diagnosed HIV-positive patients in Buffalo City Municipality, East London, South Africa. Methodology: This was a cross-sectional study of 335 newly HIV-diagnosed patients between August 2016 and July 2017. Demographic (age, gender, residence, employment status and level of education) and behavioural variables (smoking and alcohol use (past 30 days)) were by self-reporting. Information on HbA1c and other clinical variables were obtained from the medical records of the patients. Diabetes mellitus was defined based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) 2017 guideline of HbA1c of above 6.5%. Weight and height were measured using standard protocols. Logistic regression analyses were applied to determine the predictors of abnormal glycated haemoglobin. Results: Majority of the participants were female (72%). The prevalence of patients with HbA1c greater than 6.5% was 6%. The multivariate analysis indicates only age (p=0.031) and race (0.019) significantly shows a correlation to increase the risk of development of DM in newly diagnosed HIV positive patients. The binary logistic regression analysis shows that age (above 46 years) (p=0.001; AOR (6.60); CI (2.08-20.9) was directly related to the development of DM. Conclusion: Consistent with other studies, the exclusive non-fasting HbA1c, which is a marker of glycaemic control, only underestimate glycemia in HIV patients with diabetes in this present study. Notwithstanding, HIV patients who are over 40 years are likely to develop DM. As such, screening older individuals diagnosed with HIV is crucial in offering a timely point of care and interventions.

The relationship between age and glycaemic control in patients living with diabetes mellitus in the context of HIV infection: a scoping review

“…In Malawi, both of the studies suggested that age had no significance in glycaemia. 18,22 This contrasted with SA, where three studies suggested that there is an inverse relationship between age and glycaemia; 25,28,33 one study showed no significant relationship between age and glycaemia 31 while the last study showed that older patients had poorer glycaemia. 27 Overseas, both studies done in Brazil 26 and Iran 29 suggested that older age was associated with poorer glycaemia (see Table 2).…”

“…20,24,25,33 However, other studies suggested that glycaemia worsens with age. 19,23,[26][27][28][29] To complicate this, there are also data to support there being no statistically significant differences that occur between age and glycaemia. 17,18,21,22,[30][31][32] In developed countries, we found that in the 'older has worse glycaemia category' vs. 'older has improved glycaemia category' vs. 'non-significant category', there were two, two and four studies, respectively.…”