Incidence and prevalence of type 2 diabetes mellitus with HIV infection in Africa: a systematic review and meta-analysis

Abstract

ObjectivesThis systematic review aims to investigate the incidence and prevalence of type 2 diabetes mellitus (T2DM) in patients with HIV infection in African populations.SettingOnly studies reporting data from Africa were included.ParticipantsA systematic search was conducted using four databases for articles referring to HIV infection and antiretroviral therapy, and T2DM in Africa. Articles were excluded if they reported data on children, animals or type 1 diabetes exclusively.Main outcome measuresIncidence of T2DM and prevalence of T2DM. Risk ratios were generated for pooled data using random effects models. Bias was assessed using an adapted Cochrane Collaboration bias assessment tool.ResultsOf 1056 references that were screened, only 20 were selected for inclusion. Seven reported the incidence of T2DM in patients with HIV infection, eight reported the prevalence of T2DM in HIV-infected versus uninfected individuals and five reported prevalence of T2DM in HIV-treated versus untreated patients. Incidence rates ranged from 4 to 59 per 1000 person years. Meta-analysis showed no significant differences between T2DM prevalence in HIV-infected individuals versus uninfected individuals (risk ratio (RR) =1.61, 95% CI 0.62 to 4.21, p=0.33), or between HIV-treated patients versus untreated patients (RR=1.38, 95% CI 0.66 to 2.87, p=0.39), and heterogeneity was high in both meta-analyses (I2=87% and 52%, respectively).ConclusionsMeta-analysis showed no association between T2DM prevalence and HIV infection or antiretroviral therapy; however, these results are limited by the high heterogeneity of the included studies and moderate-to-high risk of bias, as well as, the small number of studies included. There is a need for well-designed prospective longitudinal studies with larger population sizes to better assess incidence and prevalence of T2DM in African patients with HIV. Furthermore, screening for T2DM using gold standard methods in this population is necessary.Trial registration numberPROSPERO42016038689.

Diabetes prevalence by HbA1c and oral glucose tolerance test among HIV-infected and uninfected Tanzanian adults

“…We report a high burden of diabetes among Tanzanian adults, with an increased risk among HIV-infected individuals. This contrasts with recent systematic reviews suggesting that in the African setting, HIV and ART are not associated with diabetes, although the reviews' findings may be limited by heterogeneity and small numbers of studies [7,29]. Although diabetes prevalence varied with the different diagnostic tests, HIV positivity, especially without ART, was generally associated with increased risk of diabetes or prediabetes.…”

“…1.84; 3.93) --- 1 Multivariate analysis included age, sex, fat mass index and fat free mass index; and all variables with overall P value <0.2 in the in univariate analyses; body mass index and cohort recruited were not included in multivariable analysis because of collinearity with other included variables. 2 Cutoff point for defining diabetes and prediabetes based on WHO criteria; RRR = Relative risk ratio; 3 Bolded estimates within variables categories has P value <0.05 4 Grip strengths tertile cut offs defined as; 0.0-23.6 for lower; 23.7-30.6 for middle and 30.7-59.6 for upper 5 Waist circumference increase is defined as �88 cm for women and � 102 cm for men 6 Fat mass index tertile cut offs defined as; 0.19-3.03 for lower; 3.04-5.76 for middle and 5.77-22.00 for upper 7 Fat-free mass index tertile cut offs defined as; 11.12-15.61 for lower; 15.62-17.20 for middle and 17.21-24.24 for upper 8 Computation included combination of total time spent in moderate and in vigorous physical activity per week 9 AZT-azidothymidine, ABC-Abacavir and TDF-Tenofovir containing regimen https://doi.org/10.1371/journal.pone.0230723.t003 24 (1.19; 4.21) 1.36 (1.02; 1.81) 2.36 (1.19; 4.64) 53 (1.14; 2.04) 4.08 (2.19;7.61) 1.52 (1.10; 1.11 Diabetes, particularly Type 2, results from insulin resistance and failure of beta-cell function, with the former preceding the latter [34]. Patients with prediabetes (impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)), a transitional state of dysglycaemia preceding diabetes diagnosis by OGTT, have different degrees of both defects (beta-cell function failure and insulin resistance) which may occur together [35].…”

“…Compared to people from high-income countries, inhabitants of SSA seem to be at risk of diabetes at younger age and may have different risk factors including HIV infection [3,5,6]. Scarce data from SSA [7] limits health system responses to non-communicable diseases (NCDs) including diabetes [2].…”

The association between various biological, behavioural and psychosocial factors and type 2 diabetes mellitus in Africa: a systematic review and meta-analysis

“…These reviews, however, focused primarily on the epidemiology of T2DM burden (e.g. prevalence, incidence) and their outcomes ( morbidity and mortality) [36][37][38][39][40][47][48][49][50][51][52] and not on the magnitude of associations. This is the rst systematic review and meta-analysis, to our knowledge, to focus on the relationships between a range of biological, behavioural and psychosocial risk factors and T2DM in Africa.…”

Prevalence of obesity, hypertension and metabolic abnormalities in patients receiving long term cART: a case control study from South India

“…7 Meanwhile a meta-analysis revealed no significant association between HIV infection or treatment and type 2 diabetes mellitus prevalence in African population studies. 8 This study was aimed to assess the prevalence of hypertension, obesity and metabolic abnormalities including blood sugar and lipid profile in patients receiving cART.…”