Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia

Faurholt‐Jepsen, Daniel; Olsen, Mette Frahm; Andersen, Anna B; Kæstel, Pernille; Abdissa, Alemseged; Amare, Hiwot; Yilma, Daniel; Girma, Tsinuel; Tesfaye, Markos; Andersen, Anita Sylvest; Friis, Henrik; Jørgensen, Marit Eika

doi:10.1097/qad.0000000000002249

Cited by 10 publications

(19 citation statements)

References 21 publications

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“…Larger proportions of both the previously malnourished groups ( Table 1 ) and the HIV-infected participants ( 13 ) had current BMI <18.5 or were in the lowest socioeconomic quintile compared with the other groups. In a previous study, HIV-infected Ethiopian adults not taking ART had lower plasma insulin both fasting and during the OGTT than in our study, but it is notable that BMI in that group was lower than in the CICADA cohort ( 38 ). Thus, it seems that associations of low prior BMI, in most cases in the CICADA population in association with HIV or tuberculosis, with low plasma insulin could be due to prolonged undernutrition or other factors associated with poverty.…”

Section: Discussioncontrasting

confidence: 77%

Prior undernutrition and insulin production several years later in Tanzanian adults

Filteau

PrayGod

Rehman

et al. 2021

The American Journal of Clinical Nutrition

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Background The prevalence, pathology, and existence of malnutrition-associated diabetes remain uncertain, especially with respect to adult-acquired undernutrition. Objective The aim was to investigate the association of prior undernutrition (low BMI, in kg/m2), acquired in adulthood and insulin during an oral glucose tolerance test (OGTT). Methods We followed up 630 adults recruited 7–14 y previously for other studies. Plasma insulin was measured fasting and at 30 and 120 min during an OGTT. The main exposure was BMI measured 7–14 y prior. The main outcome of interest was plasma insulin, controlling for time during the OGTT using generalized estimating equations, and exploratory outcomes were early insulin response (relative change in insulin and glucose from 0–30 min) and relative insulin and glucose AUCs from 0 to 120 min. Current confounding factors were age, sex, BMI, HIV, socioeconomic status, and physical activity. Results In unadjusted analyses, increasing severity of prior malnutrition was associated with lower insulin concentration. In multivariate adjusted analyses, only current BMI was a strong predictor of overall insulin concentration. Associations with prior BMI of insulin responses accounting for glucose were also seen in unadjusted but not adjusted analyses. For insulin concentration but not the outcomes accounting for glucose, there was a sex interaction with prior BMI such that only men had lower insulin if previously malnourished: insulin (pmol/L) at 120 min was 311 (95% CI: 272, 351) for prior BMI ≥18.5, 271 (95% CI: 221, 321) for prior BMI 17.0–18.5, and 237 (95% CI: 194, 297) for prior BMI <17.0; P = 0.03. HIV status showed limited and variable associations with insulin. Conclusions Insulin concentration, fasting and during an OGTT, was normalized in women more than in men several years after adult malnutrition. Chronic malnutrition, as indicated by low prior and current BMI, may contribute to diabetes through low insulin secretion.

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Section: Discussioncontrasting

confidence: 77%

Prior undernutrition and insulin production several years later in Tanzanian adults

Filteau

PrayGod

Rehman

et al. 2021

The American Journal of Clinical Nutrition

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“…Coelho et al 12 did not diagnose anyone with diabetes using HbA 1c despite FG and OGTT identifying cases of diabetes within the same population. The highest prevalence of diabetes using HbA 1c was 8.4% recorded by Faurholt‐Jepsen et al 19 in Ethiopia in a younger population with mean age of 32.9 years.…”

Section: Resultsmentioning

confidence: 90%

“…The reported prevalence ranged from 1.3% to 13.3%. 4/13 studies 12,17‐19 specified that diagnosis derived from only the 120‐min glucose value. The remaining nine articles used the WHO definition with 0‐min glucose and or the 120‐min value 20‐28 .…”

Section: Resultsmentioning

confidence: 99%

“…Studies reporting the higher prevalence of diabetes (Ngathou 16 : 26% and Ji 46 : 22.2%) used only a single FG as their diagnostic criteria which goes against WHO diagnostic criteria requiring two FG values separated in time. The lowest prevalence (Kosmiski 17 : 1.3% and Faurholt‐Jepsen 19 : 3%) used OGTT but participants in these studies only had an OGTT performed if FG was <7 mmol/L (<126 mg/dl), therefore reporting only a subgroup of people.…”

Section: Discussionmentioning

confidence: 99%

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The investigation of diabetes in people living with HIV: A systematic review

et al. 2020

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Aims HbA1c is reported to underestimate glycaemia in people living with HIV (PLHIV). There is not an internationally agreed screening method for diabetes. The primary aim was to identify which tests are performed to diagnose and monitor diabetes in PLHIV. Secondary aims were to identify whether prevalence or incidence of diabetes differs according to marker of glycaemia and how figures compare in PLHIV compared to people without. Methods Electronic databases were searched for studies investigating diabetes in PLHIV, not pregnant, aged ≥18 years. Narrative analysis and descriptive statistics were used to describe which markers of glycaemia, and their frequency, were employed in the diagnosis and monitoring of diabetes in PLHIV. Diagnostic studies provided prevalence or incidence of diabetes. Results In all, 45 of 1028 studies were included. Oral glucose tolerance test (OGTT), fasting glucose (FG), HbA1c and Fructosamine were used to investigate diabetes. In total, 27 studies described diagnosing diabetes, 14 using OGTT, 12 FG and 7 HbA1c. All 18 studies monitoring diabetes used HbA1c. Prevalence ranged from 1.3% to 26% and incidence 2.9% to 12.8%. Studies using glucose and HbA1c reported HbA1c to diagnose fewer people with diabetes, monitoring studies found HbA1c to underestimate glycaemia levels. Controlled studies demonstrate diabetes was more common in PLHIV. Conclusion OGTT was used most frequently to diagnose diabetes, and HbA1c to monitor known diabetes. Prevalence and incidence varied depending on marker of glycaemia used. Studies reported a discrepancy in accuracy of HbA1c in PLHIV, to address this, well‐designed, prospective studies, providing individual‐level data on HbA1c levels and an additional marker of glycaemia in PLHIV are needed.

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“…Furthermore, HIV accessory proteins such as Tat may result in secretion of TNF‐α, reduced insulin signalling and diminished GLUT 4 translocation [23]. We have previously shown that our participants had hyperglycaemia with insulin deficiency at the time of ART initiation [25], and the rise in fasting insulin without rise in glucose parameters in this study might also be a sign of improving insulin secretion and improving health among our participants.…”

Section: Discussionmentioning

confidence: 76%

Predictors of glucose metabolism and blood pressure among Ethiopian individuals with HIV/AIDS after one‐year of antiretroviral therapy

Amare

Olsen

Friis

et al. 2021

Tropical Med Int Health

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Objective Better understanding of glucose metabolism in patients with HIV after initiating antiretroviral therapy (ART) is important to target treatment and follow‐up for diabetes risk and other non‐communicable diseases in resource‐limited settings. The aim of this study was to assess the changes and predictors of glucose metabolism and blood pressure among patients with HIV on ART for 12 months. Methods One‐year follow‐up of Ethiopian patients with HIV after initiation of ART was done. Outcomes were changes in fasting plasma glucose (FPG), and 30‐minute (30mPG) and 2‐hour plasma glucose (2hPG) after oral glucose tolerance test, glycated haemoglobin (HbA1c), fasting plasma insulin (p‐insulin), homeostatic model assessment index for insulin resistance (HOMA‐IR) and blood pressure. Results The mean age was 33 years, and the majority were women. During the first 12 months, levels of all plasma glucose parameters decreased, while p‐insulin (10B 3.1; 95% CI2.4, 4.0), HOMA‐IR (10B 3.1; 95% CI2.3, 4.0) and systolic blood pressure (B 4.0; 95% CI2.5, 5.5) increased. Fat‐free mass at baseline predicted higher increments in p‐insulin, HOMA‐IR and blood pressure; whereas, fat mass predicted higher increment in HbA1c. Conclusions Among Ethiopian patients with HIV, blood pressure and insulin increased, and all glucose parameters declined during 12‐month of ART. Only longer‐term follow‐up will tell us whether insulin increase is due to insulin resistance or from recovering β‐cells.

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Hyperglycemia and insulin function in antiretroviral treatment-naive HIV patients in Ethiopia

Cited by 10 publications

References 21 publications

Prior undernutrition and insulin production several years later in Tanzanian adults

Prior undernutrition and insulin production several years later in Tanzanian adults

The investigation of diabetes in people living with HIV: A systematic review

Predictors of glucose metabolism and blood pressure among Ethiopian individuals with HIV/AIDS after one‐year of antiretroviral therapy

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